Importancia de la resiliencia individual y organizacional para la salud laboral del personal sanitario / Importance of individual and organizational resilience for the occupational health of healthcare workers

La resiliencia individual se refiere a las cualidades personales que permiten prosperar frente a la adversidad. La resiliencia organizacional es la capacidad de una organización para adaptarse en tiempos de crisis. Ambas variables pueden desempeñar un papel positivo en la salud de los empleados del sector sanitario, especialmente en el contexto actual de pandemia. El objetivo principal es explorar el impacto de la resiliencia individual y organizacional en la salud laboral. Se llevó a cabo un estudio transversal con cuestionarios validados, en una muestra de 311 profesionales de dos hospitales de Barcelona. Los resultados indican que una mayor resiliencia individual influye en menor fatiga, menor presencia de enfermedad y mayor satisfacción laboral. A su vez, una mayor percepción de resiliencia organizacional tiene un impacto significativo en la satisfacción laboral. Se destaca la importancia de considerar la resiliencia en los planes de intervención para la mejora de la salud laboral en el ámbito hospitalario (AU)

Individual resilience refers to the personal qualities that allow to thrive in the face of adversity. Organizational resilience is the ability of an organization to survive and grow stronger in times of crisis. Both variables can play a positive role in the health of healthcare employees, especially in the current context of a pandemic. The main objective is to explore the impact of individual and organizational resilience on occupational health. A cross-sectional study was carried out with validated questionnaires. The sample consisted of 311 professionals from two hospitals in the Barcelona region. The results indicate that higher individual resilience is related to less fatigue, less disease and greater job satisfaction. In turn, a higher perception of organizational resilience has a significant impact on job satisfaction. These results confirm the importance of considering resilience in intervention plans to improve occupational health in the health field (AU)

Repurposing a Small Community Hospital Surgical Residency Program in an Epicenter of the COVID-19 Pandemic.

BACKGROUND: COVID-19 put a stop to the operative experience of surgical residents, leaving reassignment of the team, to the frontlines. Each program has adapted uniquely; we discuss how our surgical education changed in our hospital. STUDY DESIGN: A retrospective review of changes in general surgery cases, bedside procedures, and utilization of residents before and during the pandemic. Procedures were retrieved from electronic medical records. Operating room (OR) cases 1 month before and 5 weeks after the executive order were collected. Triple lumen catheter (TLC), temporary hemodialysis catheter (HDC), and pneumothorax catheter (PC) insertions by surgical residents were recorded for 5 weeks. RESULTS: Before the pandemic, an average of 27.9 cases were done in the OR, with an average of 10.1 general surgery cases. From March 23 to April 30, 2020, the average number of cases decreased to 5.1, and general surgery cases decreased to 2.2. Elective, urgent, and emergent cases represented 83%, 14.6%, and 2.4% prior to the order and 66.7%, 15.1%, and 18.2%, respectively, after the order. Bedside procedures over 5 weeks totaled to 153, 93 TLCs, 39 HDCs, and 21 PCs. CONCLUSION: Repurposing the surgical department for the concerns of the pandemic has involved all surgical staff. We worked with other departments to allocate our team to areas of need and re-evaluated daily. The strengths of our team to deliver care and perform many bedside procedures allowed us to meet the demands posed by this disease while remaining as a cohesive unit.

Segurança do paciente em hospitais de grande porte / Patient safety in large hospitals

Objetivo: analisar a implementação da política nacional de segurança do paciente. Método: trata-se de um estudo quantitativo, descritivo e avaliativo de casos múltiplos em hospitais de grande porte. Informa-se que a coleta de dados constou de uma entrevista com o profissional responsável pelos Núcleos de Segurança do Paciente por meio de um formulário semiestruturado. Analisaram-se os dados pela estatística simples. Resultados: detalha-se que, dos 20 hospitais elegíveis, 12 (60%) participaram do estudo; todos os hospitais (100%) possuem núcleos constituídos, (91,7%) com Plano de Segurança do Paciente e (50%) contam com profissional com dedicação exclusiva. Implementaram-se, por mais da metade dos núcleos (58,3%), todos os protocolos obrigatórios, sendo identificação do paciente (83,3%) e higienização das mãos (83,3%) os mais frequentes. Revela-se que os percentuais de eventos adversos notificados foram: lesão por pressão (88,9%); queda do leito (77,8%) e erros de medicamentos (75%). Conclusão: conclui-se que os núcleos estudados não atendem totalmente às políticas regulatórias vigentes no país, merecendo, portanto, de adequações e de controle sanitário efetivo.(AU)

Objective: to analyze the implementation of the national patient safety policy. Method: this is a quantitative, descriptive and evaluative study of multiple cases in large hospitals. Please be informed that the data collection consisted of an interview with the professional responsible for the Patient Safety Centers using a semi-structured form. Data were analyzed using simple statistics. Results: it is detailed that, of the 20 eligible hospitals, 12 (60%) participated in the study; all hospitals (100%) have centers, (91.7%) have a Patient Safety Plan and (50%) have a professional with exclusive dedication. All mandatory protocols were implemented in more than half of the centers (58.3%), with patient identification (83.3%) and hand hygiene (83.3%) being the most frequent. It is revealed that the percentages of adverse events reported were: pressure injury (88.9%); bed falls (77.8%) and medication errors (75%). Conclusion: it is concluded that the centers studied do not fully comply with the regulatory policies in force in the country, therefore deserving adjustments and effective sanitary control.(AU)

Objetivo: analizar la implementación de la política nacional de seguridad del paciente. Método: se trata de un estudio cuantitativo, descriptivo y evaluativo de casos múltiples en grandes hospitales. Tenga en cuenta que la recopilación de datos consistió en una entrevista con el profesional responsable de los Centros de Seguridad del Paciente utilizando un formulario semiestructurado. Los datos se analizaron mediante estadísticas simples. Resultados: se observa que de los 20 hospitales elegibles, 12 (60%) participaron en el estudio. Se dice que todos los hospitales (100%) tienen centros constituidos, (91.7%) con un Plan de Seguridad del Paciente y (50%) tienen un profesional con dedicación exclusiva. Es de destacar que más de la mitad de los centros (58.3%) implementan todos los protocolos obligatorios, siendo la identificación del paciente (83.3%) y la higiene de manos (83.3%) las más frecuentes. Se observa que los porcentajes de eventos adversos informados fueron: lesión por presión (88,9%), caída de la cama (77,8%) y errores de medicación (75%). Conclusión: se informa que los centros estudiados no cumplen plenamente con las políticas regulatorias vigentes en el país, por lo que merecen ajustes y un control sanitario efectivo.(AU)

Predictors of a Desire to be Helpful to Professional Nurses Among Japanese Nursing Assistants in Small- to Medium-Sized Hospitals.

Registered nurses and licensed practical nurses have been educated as professional nurses. Professional nurses can concentrate on their jobs requiring a high degree of expertise with help they get from nursing assistants.If professional nurses have improper attitudes toward nursing assistants, it is most likely that the nursing assistants will not help them to the best of their ability. We investigated nursing assistants' impressions regarding professional nurses' attitudes, and what effects nursing assistants' impressions have on their "desire to be helpful to professional nurses." The study design was a cross sectional study. Twenty-five small- to medium-sized hospitals with 55 to 458 beds were included in this study. The analyzed subjects were 642 nursing assistants (96 males, 546 females). Factor analyses were conducted to extract the factors of nursing assistants' impressions regarding professional nurses' attitudes. Multiple linear regression analysis was conducted to investigate the predictors of "desire to be helpful to professional nurses." We discovered 5 factors: 1. professional nurses' model behavior, 2. manner dealing with nursing assistants, 3. respect for nursing assistants' passion for their work, 4. respect for nursing assistants' work, and 5. enhancing the ability of nursing assistants to do their work. The "desire to be helpful to professional nurses" was significantly associated with "professional nurses' model behavior," "manner dealing with nursing assistants" and "respect for nursing assistants' passion for their work." Factors 1 to 3 are fundamental principles when people establish appropriate relationships. Professional nurses must consider these fundamentals in their daily work in order to get complete cooperation from nursing assistants.

[Highlighting Service Excellence in Lorma].

Service excellence Training is an important continuing priority in Lorma Medical Center. Its design and contents are modified as needed to respond to patients' comments on the quality of service by Lorma staff. Noted inadequacies in customer satisfaction were bared in the Patient Surveys of Lorma in 2013. Floating of Satisfaction Assessments is done monthly by the Patient Relations Officer and summaries of the same are submitted by the Executive Secretary to the Department Heads concerned for immediate action, monitoring and reporting on improvements made. The premise is that process improvements should be based on data (1).

Physicians' and Nurses' Opinions about the Impact of a Computerized Provider Order Entry System on Their Workflow.

INTRODUCTION: In clinical practices, the use of information technology, especially computerized provider order entry (CPOE) systems, has been found to be an effective strategy to improve patient care. This study aimed to compare physicians' and nurses' views about the impact of CPOE on their workflow. METHODS: This case study was conducted in 2012. The potential participants included all physicians (n = 28) and nurses (n = 145) who worked in a teaching hospital. Data were collected using a five-point Likert-scale questionnaire and were analyzed using SPSS version 18.0. RESULTS: The results showed a significant difference between physicians' and nurses' views about the impact of the system on interorganizational workflow (p = .001) and working relationships between physicians and nurses (p = .017). CONCLUSION: Interorganizational workflow and working relationships between care providers are important issues that require more attention. Before a CPOE system is designed, it is necessary to identify workflow patterns and hidden structures to avoid compromising quality of care and patient safety.

Coincidental detection of the first outbreak of carbapenemase-producing Klebsiella pneumoniae colonisation in a primary care hospital, Finland, 2013.

In Finland, occurrence of Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-KP) has previously been sporadic and related to travel. We describe the first outbreak of colonisation with KPC-KP strain ST512; it affected nine patients in a 137-bed primary care hospital. The index case was detected by chance when a non-prescribed urine culture was taken from an asymptomatic patient with suprapubic urinary catheter in June 2013. Thereafter, all patients on the 38-bed ward were screened until two screening rounds were negative and extensive control measures were performed. Eight additional KPC-KP-carriers were found, and the highest prevalence of carriers on the ward was nine of 38. All other patients hospitalised on the outbreak ward between 1 May and 10 June and 101 former roommates of KPC-KP carriers since January had negative screening results. Two screening rounds on the hospital's other wards were negative. No link to travel abroad was detected. Compared with non-carriers, but without statistical significance, KPC-KP carriers were older (83 vs 76 years) and had more often received antimicrobial treatment within the three months before screening (9/9 vs 90/133). No clinical infections occurred during the six-month follow-up. Early detection, prompt control measures and repetitive screening were crucial in controlling the outbreak.

Feed First, Ask Questions Later: Alleviating and Understanding Caregiver Food Insecurity in an Urban Children's Hospital.

OBJECTIVES: We estimated the prevalence of caregiver hospital food insecurity (defined as not getting enough to eat during a child's hospitalization), examined associations between food insecurity and barriers to food access, and propose a conceptual framework to inform remedies to this problem. METHODS: We conducted a cross-sectional study of 200 caregivers of hospitalized children in Chicago, Illinois (June through December 2011). A self-administered questionnaire assessed sociodemographic characteristics, barriers to food, and caregiver hospital food insecurity. RESULTS: Caregiver hospital food insecurity was prevalent (32%). Caregivers who were aged 18 to 34 years, Black or African American, unpartnered, and with less education were more likely to experience hospital food insecurity. Not having enough money to buy food at the hospital, lack of reliable transportation, and lack of knowledge of where to get food at the hospital were associated with hospital food insecurity. The proposed conceptual framework posits a bidirectional relationship between food insecurity and health, emphasizing the interdependencies between caregiver food insecurity and patient outcomes. CONCLUSIONS: Strategies are needed to identify and feed caregivers and to eradicate food insecurity in homes of children with serious illness.

Implementation and impact of an automated group monitoring and feedback system to promote hand hygiene among health care personnel.

BACKGROUND: Despite substantial evidence to support the effectiveness of hand hygiene for preventing health care-associated infections, hand hygiene practice is often inadequate. Hand hygiene product dispensers that can electronically capture hand hygiene events have the potential to improve hand hygiene performance. A study on an automated group monitoring and feedback system was implemented from January 2012 through March 2013 at a 140-bed community hospital. METHODS: An electronic system that monitors the use of sanitizer and soap but does not identify individual health care personnel was used to calculate hand hygiene events per patient-hour for each of eight inpatient units and hand hygiene events per patient-visit for the six outpatient units. Hand hygiene was monitored but feedback was not provided during a six-month baseline period and three-month rollout period. During the rollout, focus groups were conducted to determine preferences for feedback frequency and format. During the six-month intervention period, graphical reports were e-mailed monthly to all managers and administrators, and focus groups were repeated. RESULTS: After the feedback began, hand hygiene increased on average by 0.17 events/patient-hour in inpatient units (interquartile range = 0.14, p = .008). In outpatient units, hand hygiene performance did not change significantly. A variety of challenges were encountered, including obtaining accurate census and staffing data, engendering confidence in the system, disseminating information in the reports, and using the data to drive improvement. CONCLUSIONS: Feedback via an automated system was associated with improved hand hygiene performance in the short-term.

ICU architectural design affects the delirium prevalence: a comparison between single-bed and multibed rooms*.

OBJECTIVES: Delirium risk factors are related to the patients' acute and chronic clinical condition, treatment, and environment. The environmental risk factors are essentially determined by the ICU architectural design. Although there are countless architectural variations among the ICUs, all can be classified as single- or multibed rooms. Our objectives were to compare the ICU delirium prevalence and characteristics (coma/delirium-free days, first day in delirium, and delirium motoric subtypes) of critically ill patients admitted in single- or multibed rooms. DESIGN: Retrospective. SETTING: ICU of a teaching oncologic hospital with 31 beds. Twenty-three beds distributed in one multibed room with 13 beds and other with 10 beds. Eight beds distributed in single-bed rooms. PATIENTS: All adult patients admitted from February to November 2011. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We evaluated 1,587 patients and included 1,253 patients. Patients' characteristics at ICU admission and their outcomes along the ICU stay were not different between patients admitted in single- or multibed rooms. One hundred sixty-three patients (13.0%) had delirium, and the prevalence was significantly lower in patients admitted in single-bed rooms (6.8% × 15.1%; p < 0.01). This lower prevalence occurred in patients admitted due to a medical (11.0% × 25.6%; p < 0.01) or postoperative (5.0% × 11.4%; p < 0.01) reason. However, the coma/delirium-free days, the first day in delirium, and the delirium motoric subtypes were not different between the single- and multibed rooms. The risk factors associated with delirium were admission in multibed rooms (odds ratio, 4.03; 95% CI, 2.13-7.62), older age, ICU-acquired infection, and higher Simplified Acute Physiology Score 3 and Sequential Organ Failure Assessment score. CONCLUSIONS: Critically ill patients admitted in single-bed rooms have a lower prevalence of delirium than those admitted in multibed rooms. However, coma/delirium-free days, first day in delirium, and motoric subtypes were not different.

Evaluation of hospital medication inventory policies.

As supply chain costs constitute a large portion of hospitals' operating expenses and with $27.7 billion spent by the US hospitals on drugs alone in 2009, improving medication inventory management provides a great opportunity to decrease the cost of healthcare. This study investigates different management approaches for a system consisting of one central storage location, the main pharmacy, and multiple dispensing machines located in each department. Each medication has a specific unit cost, availability from suppliers, criticality level, and expiration date. Event-driven simulation is used to evaluate the performance of several inventory policies based on the total cost and patient safety (service level) under various arrangements of the system defined by the number of drugs and departments, and drugs' criticality, availability, and expiration levels. Our results show that policies that incorporate drug characteristics in ordering decisions can address the tradeoff between patient safety and cost. Indeed, this study shows that such policies can result in higher patient safety and lower overall cost when compared to traditional approaches. Additional insights from this study allow for better understanding of the medication inventory system's dynamics and suggest several directions for future research in this topic. Findings of this study can be applied to help hospital pharmacies with managing their inventory.

Nova Scotia facility 'bigger and greener'.

Krista Wood, director of public relations for Colchester East Hants Health Authority in Canada's Nova Scotia, describes enthusiastically a new 124-bed health centre that opened late last year, which not only has the potential to conserve 44 per cent more energy than a 'traditional' hospital, but is also better equipped, and almost a third bigger, than the facility it replaces.

Initiation of an emergency department pharmacy program during economically challenging times.

PURPOSE: The initiation of a medication reconciliation program and other pharmacy services in the emergency department (ED) of a community hospital is described. SUMMARY: Despite a lack of funding for additional staff, the pharmacy department of a community hospital led an initiative to establish an ED pharmacy program; a major goal of the program was to address errors and inconsistencies in ED admission and discharge medication reconciliations. Implementing the program in a cost-neutral manner required the realignment of staff duties and schedules and an arrangement with the hospital's off-site central order-entry pharmacy contractor for expanded coverage hours. Other challenges during program implementation included securing ED workspace that afforded high visibility and easy access to the pharmacist and ensuring that pharmacy staff were qualified to provide critical care services (e.g., advanced life support, attendance at code responses, critical care drug information). After two months of operation, a review of a random sample (n = 102) of admission medication reconciliations indicated that those performed by pharmacists were significantly (p < 0.05) more likely than those conducted by nurses to meet specified accuracy criteria. An informal survey of ED physicians and nurses indicated that pharmacist involvement on the ED team was generally well received and viewed as integral to optimal ED services. CONCLUSION: Implementation of an ED pharmacist program improved the admission medication reconciliation process and provided additional services to improve patient safety and quality of care.

[Trial of preoperative consultation in outpatient clinic at a medium sized hospital].

BACKGROUND: Sometimes surgery is cancelled due to insufficiency of preoperative risk management by consultation of anesthesiologist on the day before surgery. We reported achievement of preoperative consultation in outpatient clinic at a medium sized hospital for three years. METHODS: Reservation to our clinic was performed by surgeons, when they judged that early consultation by anesthesiologist was needed by various reasons, for example severe complications and problem of past anesthesia. RESULTS: Among 737 surgical patients, 49 patients (6.6%) were consulted in our clinic and surgery was cancelled in 8 patients (16.3%). Among 688 patients who were not consulted in our clinic, we judged that early consultation was needed in 12 patients (1.7%) and surgery was cancelled in 2 patients. CONCLUSIONS: As preoperative consultation in outpatient clinic became appreciated, no patient was cancelled on the day before surgery. Moreover, our trial of preoperative consultation in outpatient clinic contributed to establishment of good relationship of anesthesiologists with surgeons and patients.

The costs of adverse drug events in community hospitals.

BACKGROUND: Adverse drug events (ADEs) occur often in hospitals, causing high morbidity and a longer length of stay (LOS), and are costly. However, most studies on the impact of ADEs have been conducted in tertiary referral centers, which are systematically different than community hospitals, where the bulk of care is delivered, and most available data about ADE costs in any setting are dated. Costs in community settings are generally lower than in academic hospitals, and the costs of ADEs might be as well. To assess the additional costs and LOS associated with patients with ADEs, a multicenter retrospective cohort study was conducted in six community hospitals with 100 to 300 beds in Massachusetts during a 20-month observation period (January 2005-August 2006). METHODS: A random sample of 2,100 patients (350 patients per study site) was drawn from a pool of 109,641 patients treated within the 20-month observation period. Unadjusted and adjusted cost of ADEs as well as LOS were calculated. RESULTS: ADEs were associated with an increased adjusted cost of $3,420 and an adjusted increase in length of stay (LOS) of 3.15 days. For preventable ADEs, the respective figures were +$3,511 and +3.37 days. The severity of the ADE was also associated with higher costs--the costs were +$2,852 for significant ADEs (LOS +2.77 days), +$3,650 for serious ADEs (LOS +3.47 days), and +$8,116 for life-threatening ADEs (LOS +5.54 days, all p < .001). CONCLUSIONS: ADEs in community hospitals cost more than $3,000 dollars on average and an average increase of LOS of 3.1 days--increments that were similar to previous estimates from academic institutions. The LOS increase was actually greater. A number of approaches, including computerized provider order entry and bar coding, have the potential to improve medication safety.