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1.
Ann R Coll Surg Engl ; 102(1): 36-42, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31660752

RESUMO

INTRODUCTION: The temporal patterns and unit-based distributions of trauma patients requiring surgical intervention are poorly described in the UK. We describe the distribution of trauma patients in the UK and assess whether changes in working patterns could provide greater exposure for operative trauma training. METHODS: We searched the Trauma Audit and Research Network database to identify all patients between 1 January 2014 to 31 December 2016. Operative cases were defined as all patients who underwent laparotomy, thoracotomy or open vascular intervention. We assessed time of arrival, correlations between mechanism of injury and surgery, and the effect of changing shift patterns on exposure to trauma patients by reference to a standard 10-hour shift assuming a dedicated trauma rotation or fellowship. RESULTS: There were 159,719 patients from 194 hospitals submitted to the Network between 2014 and 2016. The busiest 20 centres accounted for 57,568 (36.0%) of cases in total. Of these 2147/57,568 patients (3.7%) required a general surgical operation; 43% of penetrating admissions (925 cases) and 2.2% of blunt admissions (1222 cases). The number of operations correlated more closely with the number of penetrating rather than blunt admissions (r = 0.89 vs r = 0.51). A diurnal pattern in trauma admissions enabled significant increases in trauma exposure with later start times. CONCLUSIONS: Centres with high volume and high penetrating rates are likely to require more general surgical input and should be identified as locations for operative trauma training. It is possible to improve the number of trauma patients seen in a shift by optimising shift start time.


Assuntos
Educação de Pós-Graduação em Medicina/métodos , Cirurgia Geral/educação , Admissão do Paciente/estatística & dados numéricos , Traumatologia/educação , Ferimentos e Lesões/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Inglaterra , Feminino , Hospitais com Alto Volume de Atendimentos , Humanos , Irlanda , Masculino , Pessoa de Meia-Idade , Admissão e Escalonamento de Pessoal/organização & administração , Admissão e Escalonamento de Pessoal/estatística & dados numéricos , Estudos Retrospectivos , Jornada de Trabalho em Turnos/estatística & dados numéricos , Fatores de Tempo , Centros de Traumatologia/organização & administração , Centros de Traumatologia/estatística & dados numéricos , País de Gales , Local de Trabalho/organização & administração , Local de Trabalho/estatística & dados numéricos , Ferimentos e Lesões/cirurgia
2.
J R Soc Med ; 112(11): 462-471, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31710823

RESUMO

Locum doctors are often perceived to present greater risks of causing harm to patients than permanent doctors. After eligibility and quality assessment, eight empirical and 34 non-empirical papers were included in a narrative synthesis to establish what was known about the quality and safety of locum medical practice. Empirical literature was limited and weak methodologically. Locums enabled healthcare organisations to maintain appropriate staffing levels and allowed staffing flexibility, but they also gave rise to concerns about continuity of care, patient safety, team function and cost. There was some evidence to suggest that the way locum doctors are recruited, employed and used by organisations, may result in a higher risk of harm to patients. A better understanding of the quality and safety of locum working is needed to improve the use of locum doctors and the quality and safety of patient care that they provide.


Assuntos
Escolha da Profissão , Medicina de Família e Comunidade/organização & administração , Satisfação no Emprego , Segurança do Paciente/normas , Admissão e Escalonamento de Pessoal/organização & administração , Médicos/provisão & distribução , Humanos
3.
J Nurs Adm ; 49(11): 538-542, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31651613

RESUMO

A strong culture rooted in excellent nursing practice is essential to the future success of healthcare organizations. Nursing leaders face the challenge of establishing and retaining this culture with the exodus of nursing knowledge and clinical reasoning expertise from retirements of experienced nurses. This article presents a novel plan to mitigate this looming problem by rehiring and reengaging recently retired nurses to return to practice for an emeritus RN program.


Assuntos
Emprego/estatística & dados numéricos , Cuidados de Enfermagem/organização & administração , Recursos Humanos de Enfermagem/estatística & dados numéricos , Admissão e Escalonamento de Pessoal/organização & administração , Aposentadoria , Centros de Atenção Terciária/organização & administração , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Meio-Oeste dos Estados Unidos
6.
Am Surg ; 85(7): 747-751, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31405421

RESUMO

The ACGME work hour restrictions facilitated increased utilization of service-based advanced practice providers (APPs) to offset reduced general surgery resident work hours. Information regarding attending surgeon perceptions of APP impact is limited. The aim of this survey was to gauge these perceptions with respect to workload, length of stay (LOS), safety, best practice, level of function, and clinical judgment. Attending surgeons on surgical teams that employ service-based APPs at an urban tertiary referral center responded to a survey at the completion of academic year 2016. Perceptions regarding APP impact on workload, LOS, safety, best practice, level of function, and clinical judgment were examined. Twenty-two attending surgeons (40%) responded. Respondents agreed that APPs always/usually decrease their workload (77%), decrease LOS (64%), improve safety (68%), contribute to best practice (82%), and decrease near misses (71%). They also agreed that APPs decrease resident workload (87%), but fewer agreed that APPs contribute to resident education (68%). The majority perceived APPs function at the PGY1/2 (43%) or PGY3 (39%) level and always/usually trust their clinical judgment (72%), and felt there was variability in level of function among APPs (56%). This single-center study illustrates that attending surgeons perceive a positive impact on patient care by service-based APPs.


Assuntos
Atitude do Pessoal de Saúde , Internato e Residência , Admissão e Escalonamento de Pessoal/organização & administração , Adulto , Feminino , Cirurgia Geral/educação , Pesquisas sobre Serviços de Saúde , Humanos , Tempo de Internação , Masculino , Profissionais de Enfermagem , Segurança do Paciente/normas , Qualidade da Assistência à Saúde , Carga de Trabalho
7.
J Nurs Adm ; 49(9): 430-435, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31436741

RESUMO

OBJECTIVE: The purpose of this integrative literature review is to examine the effects that nurse residency programs (NRPs) have on the retention of new graduates. BACKGROUND: The Institute of Medicine recommends implementing NRPs and evaluating their effectiveness. Nursing leaders need to understand if an investment in a residency program is beneficial to their organization. METHODS: A database search was performed for research from 2010 to 2016 reporting outcomes of new graduate NRPs relating to retention. RESULTS: In the articles reviewed, the 1-year retention was higher than the national average for new graduate nurses ranging from 74% to 100%. Higher rates were associated with national programs such as the University Hospital Consortium/American Association of Colleges of Nursing or Versant compared with organization-based programs. CONCLUSIONS: NRPs can increase 1-year retention of new graduate nurses. More controlled and comparative studies are needed to evaluate program differences. Nurse leaders need evidence to ascertain which programs are the most effective in supporting retention and return on investment.


Assuntos
Competência Clínica , Educação de Pós-Graduação em Enfermagem/organização & administração , Admissão e Escalonamento de Pessoal/organização & administração , Reorganização de Recursos Humanos/estatística & dados numéricos , Preceptoria/organização & administração , Estudantes de Enfermagem/psicologia , Estudantes de Enfermagem/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Fatores de Tempo , Estados Unidos , Adulto Jovem
8.
Int J Health Care Qual Assur ; 32(6): 1004-1012, 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31282261

RESUMO

PURPOSE: The purpose of this paper is to investigate the effect of nurse staffing, nurse education and work experience on patients' length of stay (LOS) in the Greek public hospitals. DESIGN/METHODOLOGY/APPROACH: A cross-sectional study, with retrospective administrative data, was implemented. From all seven Regional Health Authorities of Greece, 25 general surgical units in 17 public hospitals participated in the study. FINDINGS: All over the hospitals were studied, 32,287 patients ⩾17 years old and 203 nursing staff, who were working in the study units, were included in the analysis. According to the multivariate linear regression model, increased years of experience as a nurse (b= -0.04, 95% CI= -0.06 to -0.02, p=0.001) and increased percentage of registered nurse to the total nursing staff (b= -1.18, CI= -1.88 to -0.47, p=0.03) were associated with decreased patient LOS. ORIGINALITY/VALUE: This was the first extended study in Greece, which explored the relationship between nurse staffing, nurse education, work experience and the LOS. The role that nurse staffing play together with its characteristics in the provision toward the quality healthcare services has already been recognized worldwide. The findings revealed the great shortage of nursing staff and the significant correlation between the work experience and educational level to patients' LOS.


Assuntos
Tempo de Internação/estatística & dados numéricos , Recursos Humanos de Enfermagem no Hospital/organização & administração , Admissão e Escalonamento de Pessoal/organização & administração , Qualidade da Assistência à Saúde , Adulto , Idoso , Competência Clínica , Estudos Transversais , Feminino , Grécia , Hospitais Públicos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
9.
Curr Opin Anaesthesiol ; 32(4): 498-503, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31246712

RESUMO

PURPOSE OF REVIEW: Although the NORA setting continues to outgrow the main operating room in cases, there are few studies addressing efficiency metrics, and even fewer studies addressing those of a single specialty outpatient gastroenterology facility. In order to capitalize on this growing trend, gastrointestinal endoscopies must be scheduled in a way that prevents lost potential revenue while maintaining patient convenience, comfort, safety, and satisfaction. By standardizing our scheduling for procedure block time among various endoscopists and converting our sedation practices from conscious sedation to solely Propofol sedation in a 4 : 1 CRNA to Anesthesiologist model, we increased revenue while maximizing physician efficiency and site utilization. RECENT FINDINGS: The commonly used main operating room efficiency benchmarks cannot effectively be applied in NORA as these two locations have widely different procedure times, turn-around-times, and recovery times. In fact, procedures in gastrointestinal endoscopy suites can be completed in less time than a typical operating room takes for turnover. SUMMARY: By adapting our sedation practices to solely Propofol sedation and by standardizing our procedural schedule times among all the endoscopists, we maximized the number of cases and revenue in our outpatient gastrointestinal endoscopy suite while increasing patient satisfaction through reduction in overall patient facility time and procedure to discharge time.


Assuntos
Instituições de Assistência Ambulatorial/organização & administração , Sedação Consciente/métodos , Eficiência Organizacional , Satisfação do Paciente , Admissão e Escalonamento de Pessoal/organização & administração , Instituições de Assistência Ambulatorial/economia , Sedação Consciente/economia , Endoscopia Gastrointestinal/efeitos adversos , Endoscopia Gastrointestinal/economia , Humanos , Dor Processual/etiologia , Dor Processual/prevenção & controle , Dor Processual/psicologia , Alta do Paciente , Admissão e Escalonamento de Pessoal/economia , Propofol/administração & dosagem , Fatores de Tempo
10.
Am J Nurs ; 119(6): 62-66, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31135435

RESUMO

This is the second article in a new series about evidence-based practice (EBP) that builds on AJN's award-winning previous series-Evidence-Based Practice, Step by Step-published between 2009 and 2011 (to access the series, go to http://links.lww.com/AJN/A133). This follow-up series will feature exemplars illustrating the various strategies that can be used to implement EBP changes-one of the most challenging steps in the EBP process.


Assuntos
Prática Clínica Baseada em Evidências/educação , Prática Clínica Baseada em Evidências/organização & administração , Recursos Humanos de Enfermagem no Hospital/educação , Recursos Humanos de Enfermagem no Hospital/organização & administração , Admissão e Escalonamento de Pessoal/organização & administração , Desenvolvimento de Pessoal/organização & administração , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
11.
Rural Remote Health ; 19(2): 5001, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31079465

RESUMO

INTRODUCTION: Recent literature has explored the health and social implications of industrial workers who are involved in a variety of long-distance commute (LDC) work arrangements including fly-in, fly-out; bus-in, bus-out; and drive-in, drive-out. However, the role of an industrial health worker in caring for this special population of workers is poorly understood and documented in current literature. In Australia, the health role has existed primarily to meet minimum standards of safety legislation and carry out compliance activities. The combination of low social risk tolerance, increasingly remote locations and changing health and safety legislation are driving changes to accountability for the health as well as the safety of remote industrial workers. Health staff are recruited from the ranks of registered nurses, paramedics and diploma-qualified medics. Often, they work in autonomous transdisciplinary roles with little connection to other health workers. The lack of a clear professional identity contributes to increased tension between the regulatory requirements of the role and organisations who don't always value input from a specialist health role. The aim of this study was to understand the experience of isolation for health workers in industrial settings to better inform industry and education providers. METHODS: A phenomenological methodology was chosen for this study owing to the paucity of qualitative literature that explored this role. This study utilised face-to-face or telephone interviews with nurses and paramedics working in remote offshore and onshore industrial health roles seeking to understand their experience of working in this context of health practice. RESULTS: Three thematically significant experiences of the role related to role dissonance, isolation, and gaining and maintaining skills. The second theme, isolation, will be presented to provide context for nurses' and paramedics' experiences of geographical, personal and professional isolation. CONCLUSIONS: Nurses and paramedics working in remote industrial roles are not prepared for the broad scope of practice of the role, and the physical and profession isolation presents barriers to obtaining skills and confidence necessary to meet the needs of the role. Limited resources in rural and remote areas combined with the isolation of many industrial sites pose challenges for industrial staff in accessing primary healthcare services, yet industrial organisations are resisting attempts to make them responsible for the health as well as the safety of their onsite workers, particularly in off-duty hours. Health workers in remote locations have to cope with their own experience of isolation but also have to treat and counsel other industrial workers experiencing chronic illness complications, separation from family and other consequences of the fly-in, fly-out 'workstyle'. In addition to the tyranny presented by distance and the emotional isolation common to all remote industrial workers, health workers are isolated from professional networks, access to education/professional development opportunities and other remote industrial peers. Their inclusion within a professional network and educational framework would help to mitigate these factors and provides opportunities for collaboration between industrial and rural health staff.


Assuntos
Auxiliares de Emergência/psicologia , Mão de Obra em Saúde/organização & administração , Recursos Humanos de Enfermagem/psicologia , Serviços de Saúde Rural/organização & administração , Transportes/estatística & dados numéricos , Tolerância ao Trabalho Programado/psicologia , Austrália , Auxiliares de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Recursos Humanos de Enfermagem/estatística & dados numéricos , Admissão e Escalonamento de Pessoal/organização & administração
12.
J Nurs Adm ; 49(6): 291-293, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31135635

RESUMO

Designing and improving efficient, effective staffing models remain a top priority for chief nurse executives (CNEs). However, market forces are pushing the need for staffing model innovation. Both innovative and widely debated in professional and academic circles, differentiated nursing practice has yet to be widely adopted. CNEs are challenged to revisit new realities and confront organizational, professional, and culture barriers that are impeding this staffing model innovation.


Assuntos
Modelos Organizacionais , Enfermeiras Administradoras/psicologia , Inovação Organizacional , Admissão e Escalonamento de Pessoal/organização & administração , Humanos
13.
J Nurs Adm ; 49(5): 260-265, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31008835

RESUMO

OBJECTIVE: To examine whether healthcare-associated infections (HAIs) and nurse staffing are associated using unit-level staffing data. BACKGROUND: Previous studies of the association between HAIs and nurse staffing are inconsistent and limited by methodological weaknesses. METHODS: Cross-sectional data between 2007 and 2012 from a large urban hospital system were analyzed. HAIs were diagnosed using the Centers for Disease Control and Prevention's National Healthcare Safety Network definitions. We used Cox proportional-hazards regression model to examine the association of nurse staffing (2 days before HAI onset) with HAIs after adjusting for individual risks. RESULTS: Fifteen percent of patient-days had 1 shift understaffed, defined as staffing below 80% of the unit median for a shift, and 6.2% had both day and night shifts understaffed. Patients on units with both shifts understaffed were significantly more likely to develop HAIs 2 days later. CONCLUSIONS: Understaffing is associated with increased risk of HAIs.


Assuntos
Infecção Hospitalar , Hospitais Urbanos/estatística & dados numéricos , Recursos Humanos de Enfermagem no Hospital/organização & administração , Recursos Humanos de Enfermagem no Hospital/estatística & dados numéricos , Admissão e Escalonamento de Pessoal/organização & administração , Admissão e Escalonamento de Pessoal/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estados Unidos
14.
J Med Syst ; 43(6): 147, 2019 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-31011825

RESUMO

Increased healthcare costs and diminishing returns have prompted healthcare administrators to address budget allocations to alleviate institutional costs. Current economic constraints, such as limited Medicaid and Medicare insurance payments, limit our patients' ability to receive urgent surgical interventions as well as access preventative diagnostic tools. Rather than downsizing the workforce, future sustainability must be derived upon effective cost structures supported by improved quality control measures and increased patient accessibility. Surgeries were performed during 29% of hospitalizations and comprised 48% of the $387 billion in healthcare expenditures in 2011. Further, surgical procedures managed to account for 40-70% of hospital revenues. Effective cost reduction begins at the source and in the case of hospital systems, the operating room (OR). Taking this into consideration, administrators evaluating future revenue streams should look to consider OR-based cost reduction measures as part of their first step approach. Improving OR efficiency through block time and staff optimization remain the premise of today's existing literature on OR management strategies.


Assuntos
Eficiência Organizacional , Salas Cirúrgicas/organização & administração , Melhoria de Qualidade/organização & administração , Agendamento de Consultas , Análise Custo-Benefício , Humanos , Salas Cirúrgicas/economia , Admissão e Escalonamento de Pessoal/organização & administração , Estados Unidos
16.
Int J Health Care Qual Assur ; 32(2): 499-515, 2019 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-31017064

RESUMO

PURPOSE: In order to provide access to care in a timely manner, it is necessary to effectively manage the allocation of limited resources. such as beds. Bed management is a key to the effective delivery of high quality and low-cost healthcare. The purpose of this paper is to develop a discrete event simulation to assist in planning and staff scheduling decisions. DESIGN/METHODOLOGY/APPROACH: A discrete event simulation model was developed for a hospital system to analyze admissions, patient transfer, length of stay (LOS), waiting time and queue time. The hospital system contained 50 beds and four departments. The data used to construct the model were from five years of patient records and contained information on 23,019 patients. Each department's performance measures were taken into consideration separately to understand and quantify the behavior of departments individually, and the hospital system as a whole. Several scenarios were analyzed to determine the impact on reducing the number of patients waiting in queue, waiting time and LOS of patients. FINDINGS: Using the simulation model, it was determined that reducing the bed turnover time by 1 h resulted in a statistically significant reduction in patient wait time in queue. Further, reducing the average LOS by 10 h results in statistically significant reductions in the average patient wait time and average patient queue. A comparative analysis of department also showed considerable improvements in average wait time, average number of patients in queue and average LOS with the addition of two beds. ORIGINALITY/VALUE: This research highlights the applicability of simulation in healthcare. Through data that are often readily available in bed management tracking systems, the operational behavior of a hospital can be modeled, which enables hospital management to test the impact of changes without cost and risk.


Assuntos
Ocupação de Leitos/métodos , Simulação por Computador , Técnicas de Apoio para a Decisão , Eficiência Organizacional , Admissão e Escalonamento de Pessoal/organização & administração , Humanos , Tempo de Internação/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Transferência de Pacientes/normas , Fatores de Tempo , Listas de Espera
17.
J Med Syst ; 43(5): 139, 2019 Apr 10.
Artigo em Inglês | MEDLINE | ID: mdl-30972511

RESUMO

Hospital scheduling presents huge challenges for the healthcare industry. Various studies have been conducted in many different countries with focus on both elective and non-elective surgeries. There are important variables and factors that need to be taken into considerations. Different methods and approaches have also been used to examine hospital scheduling. Notwithstanding the continuous changes in modern healthcare services and, in particular, hospital operations, consistent reviews and further studies are still required. The importance of hospital scheduling, particularly, has become more critical as the trade-off between limited resources and overwhelming demand is becoming more evident. This situation is even more pressing in a volatile country where shootings and bombings in public areas happened. Hospital scheduling for elective surgeries in volatile country such as Iraq is therefore often interrupted by non-elective surgeries due to war-related incidents. Hence, this paper intends to address this issue by proposing a hospital scheduling model with focus on neuro-surgery department. The aim of the model is to maximize utilization of operating room while concurrently minimizing idle time of surgery. The study focused on neurosurgery department in Al-Shahid Ghazi Al-Hariri hospital in Baghdad, Iraq. In doing so, a Mixed-integer linear programming (MILP) model is formulated where interruptions of non-elective surgery are incorporated into the main elective surgery based model. Computational experiment is then carried out to test the model. The result indicates that the model is feasible and can be solved in reasonable times. Nonetheless, its feasibility is further tested as the problems size and the computation times is getting bigger and longer. Application of heuristic methods is the way forward to ensure better practicality of the proposed model. In the end, the potential benefit of this study and the proposed model is discussed.


Assuntos
Agendamento de Consultas , Conflitos Armados/estatística & dados numéricos , Eficiência Organizacional/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Salas Cirúrgicas/organização & administração , Algoritmos , Hospitais Públicos/organização & administração , Humanos , Iraque , Modelos Teóricos , Admissão e Escalonamento de Pessoal/organização & administração , Estudos Prospectivos , Melhoria de Qualidade/organização & administração , Fatores de Tempo
18.
Qual Manag Health Care ; 28(2): 78-83, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30921281

RESUMO

BACKGROUND: Standardized hospital mortality ratios (SHMRs) are widely used for quality improvement, hospital ratings, and health care payment. OBJECTIVES: (1) To characterize the programs implemented at hospitals in response to SHMRs.(2) To describe hospital leaders' perceptions of SHMRs as indicators of care quality. METHODS: Electronic survey of administrative leaders at US academic medical centers who subscribed to Vizient leadership networks. RESULTS: Forty-seven administrative leaders from 37 US academic medical centers completed the survey. Respondents reported that SHMRs had the largest role in the decision to implement inpatient hospice programs, electronic early warning systems, and clinical documentation specialist programs at their institution. Respondents perceived clinical documentation specialist programs and condition-specific care pathways as the most effective programs to improve performance on SHMRs. Only 29% of respondents agreed that SHMRs accurately reflect the number of preventable deaths in hospitals, but 78% agreed that SHMRs have helped their hospital reduce preventable deaths. CONCLUSIONS: Hospitals have employed various strategies in response to SHMRs-including clinical programs that focus on reducing preventable deaths and other programs that target improvement in SHMR performance without reducing preventable deaths. Hospital administrative leaders identify significant benefits and flaws of SHMRs as quality indicators.


Assuntos
Administração Hospitalar , Administradores Hospitalares/organização & administração , Mortalidade Hospitalar/tendências , Melhoria de Qualidade/organização & administração , Indicadores de Qualidade em Assistência à Saúde/organização & administração , Centros Médicos Acadêmicos , Procedimentos Clínicos/normas , Documentação/normas , Cuidados Paliativos na Terminalidade da Vida/organização & administração , Equipe de Respostas Rápidas de Hospitais/organização & administração , Humanos , Liderança , Admissão e Escalonamento de Pessoal/organização & administração , Qualidade da Assistência à Saúde/organização & administração , Estados Unidos
19.
J Nurs Adm ; 49(4): 221-227, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30882611

RESUMO

Registered nurses are the backbone of America's health systems, providing care and support to patients across the lifespan. Appropriate nurse staffing is critical to ensure safe and effective care for patients. Nurse staffing is a complex topic; nurse administrators find themselves facing escalating challenges to meet staffing needs. These challenges can be attributed to a variety of factors, both historical and new. This article examines the current factors contributing to nursing shortages, nurse staffing challenges, and the implications of inappropriate staffing on both financial and patient outcomes.


Assuntos
Enfermeiras Administradoras/organização & administração , Recursos Humanos de Enfermagem no Hospital/organização & administração , Admissão e Escalonamento de Pessoal/organização & administração , Envelhecimento , Humanos , Enfermeiras Administradoras/psicologia , Recursos Humanos de Enfermagem no Hospital/normas , Carga de Trabalho/psicologia
20.
Int J Health Care Qual Assur ; 32(1): 59-70, 2019 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-30859880

RESUMO

PURPOSE: The purpose of this paper is to develop a chemotherapy scheduling template that accounts for nurse resource availability and patient treatment needs to alleviate the mid-day patient load and provide quality services for patients. DESIGN/METHODOLOGY/APPROACH: Owing to treatment complexity in chemotherapy administration, nurses are required at the beginning, end and during treatment. When nurses are not available to continue treatment, the service is compromised, and the resource constraint is violated, which leads to inevitable delay that risks service quality. Consequently, an optimization method is used to create a scheduling template that minimizes the violation between resource assignment and treatment requirements, while leveling patient load throughout a day. A case study from a typical clinic day is presented to understand current scheduling issues, describe nursing resource constraints, and develop a constraint-based optimization model and leveling algorithm for the final template. FINDINGS: The approach is expected to reduce the variation in the system by 24 percent and result in five fewer chemo chairs used during peak hours. Adjusting staffing levels could further reduce resource constraint violations and more savings on chair occupancy. The actual implementation results indicate a 33 percent reduction on resource constraint violations and positive feedback from nursing staff for workload. RESEARCH LIMITATIONS/IMPLICATIONS: Other delays, including laboratory test, physician visit and treatment assignment, are potential research areas. ORIGINALITY/VALUE: The study demonstrates significant improvement in mid-day patient load and meeting treatment needs using optimization with a unique objective.


Assuntos
Tratamento Farmacológico/normas , Enfermagem Oncológica/organização & administração , Admissão e Escalonamento de Pessoal/organização & administração , Gestão da Qualidade Total/organização & administração , Carga de Trabalho , Centros Médicos Acadêmicos , Assistência Ambulatorial/organização & administração , Tratamento Farmacológico/tendências , Feminino , Humanos , Masculino , Minnesota , Relações Enfermeiro-Paciente , Recursos Humanos de Enfermagem no Hospital/organização & administração , Segurança do Paciente , Pesquisa Qualitativa
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