Many U.S. Patients Believe Their Hospital Falls Short in Addressing Basic Quality Issues
While patients in U.S. hospitals are generally satisfied with their care, satisfaction levels are not as high as they could be, and rise significantly when hospitals have more nurses at bedside, a new Commonwealth Fund-supported study finds.
Published today in The New England Journal of Medicine, the study, conducted by researchers at the Harvard School of Public Health, reveals that patients frequently feel hospitals fall short in addressing basic quality issues--controlling pain, communicating about medications, and coordinating discharge planning. More than 2,400 hospitals nationally were included in the analysis.
While two-thirds of patients gave their hospital care a high rating, very few hospitals received the highest rating from 90 percent or more of their patients. The performance of for-profit hospitals was worse than that of private and nonprofit hospitals in all areas, but differences between teaching and non-teaching hospitals were small and insignificant. On average, patients at hospitals that have a higher number of nurses available at bedside rated their experiences as better, with the ratio of nurses to patient days a critical predictor of patients' overall ratings."
Our analysis shows that hospitals can do a lot better at providing patient-centered care," said Ashish Jha, M.D., the study's lead author. "The good news is that publicizing hospital performance is likely to stimulate improvements in the future, since hospitals will now have benchmark data to compare how they are doing."
Friday, October 31, 2008
Tuesday, August 5, 2008
Are you stressed out?
Occupational stress has been a long-standing concern of the health care industry. Studies indicate that health care workers have higher rates of substance abuse and suicide than other professions and elevated rates of depression and anxiety linked to job stress. In addition to psychological distress, other outcomes of job stress include burnout, absenteeism, employee intent to leave, reduced patient satisfaction, and diagnosis and treatment errors.
Click here for a copy of Exposure to Stress: Occupational hazards in health care, published by the US Department of Human Services, Center for Disease Control, and National Institute on Occupational Safety & Health.
Click here for a copy of Exposure to Stress: Occupational hazards in health care, published by the US Department of Human Services, Center for Disease Control, and National Institute on Occupational Safety & Health.
Code Green
Tossing out everything from plastic bandages and cotton swabs to hospital robes after a single use, the U.S. medical industry generates more than 2 million tons of waste per year, environmental advocates say. Some of that waste makes its way to incinerators and, when burned, releases dioxin, mercury and other toxins. Is it ironic that the industry we trust to protect our health is releasing substances that may be tied to cancer, diabetes and other illnesses? Many health-care professionals think so.
Click here to read Washington Post article
Click here to read Washington Post article
Indiana Hospital involves staff to design optimal work environment
Teams of staff members representing every department at Parkview Health in Fort Wayne, Indiana have helped to develop innovations in the design of new patient care units that will create a "healing, nurse-friendly environment".
Staff are giving input and choosing room configurations, bathroom locations, height of nursing station counters, types of beds and even electrical outlet placements for various kinds of equipment.
Medical-surgical units, for instance, will be configured as pods containing 12 private rooms, all equipped with windows to give nurses a clear line of sight for patient monitoring. The hospital also will feature wireless communications technology to facilitate nurse-patient contact, blood pressure cuffs on either side of the bed to accommodate both right- and left-handed clinicians, "smart bed" technology to alert nurses when a patient has gotten out of bed, and ceiling-mounted lifts to prevent injuries to staff and patients. In addition, the plans call for bedside computers in every room to reduce the risk of infection, which increases when computer carts must be wheeled from patient to patient. Dedicated patient education rooms, meanwhile, will allow providers and patients to have private conversations about home care, and a designated nurse quiet room will provide nurses with a place to rejuvenate during a stressful day.
To read more, click here.
Staff are giving input and choosing room configurations, bathroom locations, height of nursing station counters, types of beds and even electrical outlet placements for various kinds of equipment.
Medical-surgical units, for instance, will be configured as pods containing 12 private rooms, all equipped with windows to give nurses a clear line of sight for patient monitoring. The hospital also will feature wireless communications technology to facilitate nurse-patient contact, blood pressure cuffs on either side of the bed to accommodate both right- and left-handed clinicians, "smart bed" technology to alert nurses when a patient has gotten out of bed, and ceiling-mounted lifts to prevent injuries to staff and patients. In addition, the plans call for bedside computers in every room to reduce the risk of infection, which increases when computer carts must be wheeled from patient to patient. Dedicated patient education rooms, meanwhile, will allow providers and patients to have private conversations about home care, and a designated nurse quiet room will provide nurses with a place to rejuvenate during a stressful day.
To read more, click here.
Thursday, July 10, 2008
Nurses and other caregivers face workplace assaults
An article published in The New York Times on July 8, 2008 reported that, according to the federal Bureau of Labor Statistics, half of all nonfatal injuries resulting from workplace assaults occur in health care and social service settings.
Nurses and other personal care workers bear the brunt of such attacks, with 25 injuries annually resulting in days off from work for every 10,000 full-time workers — 12 times the rate of the overall private sector, according to the bureau. The most dangerous settings are psychiatric units and nursing homes, where patients are often confused, disoriented or suffering from mental ailments, as well as emergency rooms, where long waits for care can anger patients, and the people with them.
Click here to read the entire New York Times article.
Nurses and other personal care workers bear the brunt of such attacks, with 25 injuries annually resulting in days off from work for every 10,000 full-time workers — 12 times the rate of the overall private sector, according to the bureau. The most dangerous settings are psychiatric units and nursing homes, where patients are often confused, disoriented or suffering from mental ailments, as well as emergency rooms, where long waits for care can anger patients, and the people with them.
Click here to read the entire New York Times article.
Monday, July 7, 2008
ANA Study: Workplace Safety Could Worsen RN Shortage
A new survey from the American Nurses Association (ANA) finds that 55 percent of U.S. nurses believe their work environment jeopardizes their personal safety, a concern that experts say could drive nurses to leave the profession, Occupational Hazards reports.
Based on responses from approximately 700 nurses, the 2008 Study of Nurses' Views on Workplace Safety and Needlestick Injuries indicates that 64 percent of U.S. nurses have experienced an accidental needlestick injury while working during their career. Among those who reported experiencing needlestick injuries, 75 percent said the incidents were associated with the use of standard, non-safety syringes, even though 97 percent of respondents indicated that safety syringes were available in their facility and 75 percent were provided training on needlestick prevention.
Meanwhile, respondents overwhelmingly pointed to increasing workloads and workplace stress levels as factors in workplace safety, and nearly 60 percent of nurses indicated that mounting pressures have forced them to work faster, even if shortcuts were required. According to the report, 87 percent of nurses also said that perceptions of safety in the workplace influenced the type of nursing they practice and their continued practice in the field. In terms of improving working conditions, 68 percent of nurses reported advocating for safety in the workplace, with 29 percent reporting that they are their own primary advocate.
Commenting on the findings, the researchers note that "to enhance the safety climate of all health care workers, improvements need to be made to the workplace environment and staffing levels." (Walter, Occupational Hazards, 6/28/08; ANA release, 6/24/08)
Based on responses from approximately 700 nurses, the 2008 Study of Nurses' Views on Workplace Safety and Needlestick Injuries indicates that 64 percent of U.S. nurses have experienced an accidental needlestick injury while working during their career. Among those who reported experiencing needlestick injuries, 75 percent said the incidents were associated with the use of standard, non-safety syringes, even though 97 percent of respondents indicated that safety syringes were available in their facility and 75 percent were provided training on needlestick prevention.
Meanwhile, respondents overwhelmingly pointed to increasing workloads and workplace stress levels as factors in workplace safety, and nearly 60 percent of nurses indicated that mounting pressures have forced them to work faster, even if shortcuts were required. According to the report, 87 percent of nurses also said that perceptions of safety in the workplace influenced the type of nursing they practice and their continued practice in the field. In terms of improving working conditions, 68 percent of nurses reported advocating for safety in the workplace, with 29 percent reporting that they are their own primary advocate.
Commenting on the findings, the researchers note that "to enhance the safety climate of all health care workers, improvements need to be made to the workplace environment and staffing levels." (Walter, Occupational Hazards, 6/28/08; ANA release, 6/24/08)
Wednesday, June 25, 2008
Nurses Want to Leave Hospitals Due to 'Moral Distress'
A study from the University of Pennsylvania School of Nursing has found that 25 percent of practicing nurses and social workers experience "moral distress" causing them to want to leave their current positions, and fully 41 percent failed to say they would chose their profession again.
In one of the first studies to investigate the relationship between ethics and intent to leave, Penn Nursing assistant professor Connie Ulrich, PhD, RN, found "moral distress" led to feelings of powerlessness (32.5 percent), feeling overwhelmed (34.7 percent), frustration (52.8 percent) and fatigue (40 percent), noting that the nurses' desire to leave is in part fueled by experiencing more "ethical stress" and an inadequate level of institutional support for dealing with ethical decisions, as well as a perception of little respect for their profession. The study's findings were published in Social Science and Medicine.
Issues causing moral distress include protecting patients' rights, supporting them through difficult decisions at the end of life, and fairly distributing resources. "Nurses reported feeling that they cannot adequately protect patient's rights or the informed decisions of patients and must balance these and other conflicting issues with a hospital's bottom line," Ulrich said.
Click here to read more.
In one of the first studies to investigate the relationship between ethics and intent to leave, Penn Nursing assistant professor Connie Ulrich, PhD, RN, found "moral distress" led to feelings of powerlessness (32.5 percent), feeling overwhelmed (34.7 percent), frustration (52.8 percent) and fatigue (40 percent), noting that the nurses' desire to leave is in part fueled by experiencing more "ethical stress" and an inadequate level of institutional support for dealing with ethical decisions, as well as a perception of little respect for their profession. The study's findings were published in Social Science and Medicine.
Issues causing moral distress include protecting patients' rights, supporting them through difficult decisions at the end of life, and fairly distributing resources. "Nurses reported feeling that they cannot adequately protect patient's rights or the informed decisions of patients and must balance these and other conflicting issues with a hospital's bottom line," Ulrich said.
Click here to read more.
Tuesday, June 24, 2008
How much time do you actually spend at the bedside?
Study Finds Nurses Spend Bulk of Time Away from Bedside
A study in The Permanente Journal finds that nurses devote more than 75 percent of their time to nursing practice but spend only about one-third of that in patient rooms, Modern Healthcare reports.
Supported by the Robert Wood Johnson Foundation and the Gordon and Betty Moore Foundation, the study assigned 767 licensed nurses from 36 medical-surgical units within 17 health care systems in 15 states to carry hand-held computers, four sensors to track movement and an armband that recorded physiological responses for 23 hours each day during one week.
In analyzing nurses' daily activities, researchers found that documentation required the most time, accounting for roughly 2.5 hours of every 10-hour shift. Care coordination was the next most time-intensive activity, occupying roughly 86 minutes per shift, followed by medication administration at about 72 minutes per shift, and patient assessments and the reading of vital signs at roughly 31 minutes per shift. In addition, the researchers found that nurses spent an average of 36 minutes per shift waiting for, delivering or searching for items, activities that the researchers note "are clearly targets for improving efficiency."
In terms of location during nursing practice, nurses spent 37.4 percent of their time in patient rooms, 43.3 percent of their time at the nurse station, 17.6 percent of their time on the patient unit and 1.6 percent of their time off the unit.
Commenting on this breakdown, the researchers note that the majority of documentation and care coordination activities take place at the nurse station. They add, meanwhile, that the nurses walked an average of 3.1 miles per shift, time that the researchers say could be better spent tending to patients. Based on their findings, the researchers identify three main targets for reducing inefficiency, including documentation, medication administration and care coordination. Specifically, they recommend that hospitals focus their efforts on improving technology, work processes, and unit organization and design, noting that changes to those areas could "allow for substantial improvements in the use of nurses' time and the safe delivery of care."
A study in The Permanente Journal finds that nurses devote more than 75 percent of their time to nursing practice but spend only about one-third of that in patient rooms, Modern Healthcare reports.
Supported by the Robert Wood Johnson Foundation and the Gordon and Betty Moore Foundation, the study assigned 767 licensed nurses from 36 medical-surgical units within 17 health care systems in 15 states to carry hand-held computers, four sensors to track movement and an armband that recorded physiological responses for 23 hours each day during one week.
In analyzing nurses' daily activities, researchers found that documentation required the most time, accounting for roughly 2.5 hours of every 10-hour shift. Care coordination was the next most time-intensive activity, occupying roughly 86 minutes per shift, followed by medication administration at about 72 minutes per shift, and patient assessments and the reading of vital signs at roughly 31 minutes per shift. In addition, the researchers found that nurses spent an average of 36 minutes per shift waiting for, delivering or searching for items, activities that the researchers note "are clearly targets for improving efficiency."
In terms of location during nursing practice, nurses spent 37.4 percent of their time in patient rooms, 43.3 percent of their time at the nurse station, 17.6 percent of their time on the patient unit and 1.6 percent of their time off the unit.
Commenting on this breakdown, the researchers note that the majority of documentation and care coordination activities take place at the nurse station. They add, meanwhile, that the nurses walked an average of 3.1 miles per shift, time that the researchers say could be better spent tending to patients. Based on their findings, the researchers identify three main targets for reducing inefficiency, including documentation, medication administration and care coordination. Specifically, they recommend that hospitals focus their efforts on improving technology, work processes, and unit organization and design, noting that changes to those areas could "allow for substantial improvements in the use of nurses' time and the safe delivery of care."
Friday, June 20, 2008
No pay for medical errors
Massachusetts adopts no-pay policy on medical errors
Providence Business News
BOSTON – Under a landmark policy, the Bay State will no longer pay for costs associated with certain “serious reportable health-care events” such as wrong-side surgery. The state also will forbid its providers to bill members for such expenses.
“The alignment of payment policies on serious reportable events was identified as an early priority of HealthyMass and reflects the commonwealth’s commitment to maximizing quality of care,” Secretary of Health and Human Services Dr. JudyAnn Bigby, who chairs the HealthyMass executive committee, said in a statement. “By adopting a consistent policy, Massachusetts is applying the state’s purchasing power in support of patient safety.” Click here to read entire article
Providence Business News
BOSTON – Under a landmark policy, the Bay State will no longer pay for costs associated with certain “serious reportable health-care events” such as wrong-side surgery. The state also will forbid its providers to bill members for such expenses.
“The alignment of payment policies on serious reportable events was identified as an early priority of HealthyMass and reflects the commonwealth’s commitment to maximizing quality of care,” Secretary of Health and Human Services Dr. JudyAnn Bigby, who chairs the HealthyMass executive committee, said in a statement. “By adopting a consistent policy, Massachusetts is applying the state’s purchasing power in support of patient safety.” Click here to read entire article
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