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NURSES: Average age of hospital RNs is about 43

The average age of RNs working in hospitals has held constant at about 43 years old for at least the past 10 years, according to one of my favorite sources of data on nurse staffing — the Survey of Hours Report — conducted and published by the Labor Management Institute.  Interestingly, this statistic does not vary much based on whether the hospital is a teaching hospital, a community hospital, or a rural hospital.  The findings are based on a survey taken each year, to which about 200 hospitals nationwide respond.

Most of this report is devoted to survey results related to RN to patient ratios for different types of nursing units, hours per patient day for different units, turnover, vacancy, time to hire, patient falls rates, medication error rates, and LOTS of other interesting statistics.

Source: 2014 PSS Survey of Hours Report.  Bloomington, Minn.: Labor Management Institute, p. 448.  [And earlier editions.]  http://lminstitute.com/products  Posted by AHA Resource Center (312) 422-2050 rc@aha.org

What happens in a government shutdown?

September 30 marks the end of the federal government’s fiscal year, which makes early fall one key time when political contention sometimes brings the threat of a government shutdown.  Sometimes it remains merely a threat, but there were, in fact, shutdowns in 1995 (21 days) and in 2013 (16 days).  I am writing this post on September 30, 2015, and the New York Times is reporting today that it looks like a shutdown will be averted this year.

However, agencies prepared contingency plans for a 2015 shutdown – and you can read them on the website of the Office of Management and Budget here:  https://www.whitehouse.gov/omb/contingency-plans

Modern Healthcare reported that a short shutdown would probably not have much impact on health care providers.  Medicare reimbursement comes from a trust fund separate from annual federal appropriations.  Veterans Affairs hospitals were expected to remain open.

A particular challenge for 2015 would be trying to implement the ICD-10 coding system at the time that a government shutdown would hit.


Herszenhorn, D.M. (2015, Sept. 30). Senate passes spending bill to avert government shutdown. The New York Times. http://www.nytimes.com/2015/10/01/us/politics/government-shutdown-congress.html?_r=0

Kessler, G. (2011, Feb. 25). Lessons from the great government shutdown of 1995-1996. The Washington Post. http://voices.washingtonpost.com/fact-checker/2011/02/lessons_from_the_great_governm.html

Kutscher, B. (2015, Sept. 28). Prolonged government shutdown would affect providers. Modern Healthcare, 45(39), 4.  http://www.modernhealthcare.com/article/20150926/MAGAZINE/309269941/prolonged-government-shutdown-would-affect-providers

Conn, J. (2015, Sept. 28). CMS preps for an upload and a shutdown. Modern Healthcare, 45(39), 4.  http://www.modernhealthcare.com/article/20150926/MAGAZINE/309269940

Mercia, D. (2013, Oct. 4). 995 and 2013: three differences between two shutdowns. CNN Politicshttp://www.cnn.com/2013/10/01/politics/different-government-shutdowns/

HOSPITAL DESIGN: Location of OR in relation to ED?

Some years ago, I was asked to find articles that mentioned where the emergency department was in relation to the surgical suite in hospitals.  A recent article on this topic (the one about Parkland below) caught my eye for that reason, and I decided to see what else might come up in a quick search of the literature.

Advice from Hayward & Associates (architects and space planners)

  • Emergency department entrance should be at grade level
  • These areas should be adjacent to the ED or directly accessible via elevator: Surgical suite, intensive care units, labor and delivery
  • The elevator should be oversized – large enough for stretcher, staff, and pieces of patient care equipment
  • If trauma service is provided – there must be a direct route from ED to surgical suite.  This can be a dedicated corridor if the departments are on the same level, or via elevator

CASE STUDY: Albert Einstein Medical Center (Philadelphia, PA) – 2009 article

  • Surgical suite is three floors above the ED
  • Cath lab is one floor above the ED

CASE STUDY: Carilion Roanoke Memorial Hospital (Roanoke, VA) – 2003 article

  • Cardiac cath labs and cardiac OR is four floors above ED and imaging departments

CASE STUDY: Emory University Hospital (Atlanta, GA) – 2014 article

  • Cath lab on 4th floor
  • Surgical suite on 3rd floor
  • ED on 1st floor

CASE STUDY: Florida Hospital (Orlando, FL) – 2011 article

  • Cath lab is 2 floors directly above the ED
  • Surgical suite is also 2 floors above the ED – but at some distance from the cath lab

CASE STUDY: Mercy Hospital (Springfield, MO) – 2012 article

  • Surgical suite is 2 floors above the ED
  • Cath lab is 3 floors above the ED
  • At the time this was written, they were anticipating a new heart institute project which would put the cath lab adjacent to the surgical suite.

CASE STUDY: Parkland Hospital (Dallas, TX) – 2015 article

  • New replacement hospital
  • ED designed for 180,000 visits per year
  • 154 treatment rooms in pods of 12 or 14
  • There are 4 trauma rooms – equipped as surgical suites – in the ED
  • The surgical suite is two floors above the ED
  • There are two trauma elevators – the largest dubbed the ‘megavator’

CASE STUDY: St. Agnes Medical Center (Fresno, CA) – 2015 article

  • Cardiothoracic services (3 cath lab suites and 4 dedicated operating rooms) are located 2 floors above the ED

CASE STUDY: University Health System (San Antonio, TX) – 2007 article

  • ED is on the sublevel with cath labs close by
  • Imaging is two floors up
  • Surgical suite is on the 11th floor
  • There are trauma elevators


Hayward, C. (2015). SpaceMed guide: A space planning guide for healthcare facilities. (3rd ed.). Ann Arbor, Mich.: HA Ventures, p. 1-12 to 1-13, and 2-15 to 2-16.

[About Albert Einstein]. Visco, J., and Irwin, G.H. (2009, Aug.). Albert Einstein Medical Center. Cath Lab Digest, 17(8). Retrieved from http://www.cathlabdigest.com/articles/Albert-Einstein-Medical-Center

[About Carilion]. Smith, C.D. (2003, Sept.). Carilion Roanoke Memorial Hospital. Cath Lab Digest11(9). Retrieved from http://www.cathlabdigest.com/articles/Carilion-Roanoke-Memorial-Hospital

[About Emory]. Sarpong, N. (2014, Dec.). Spotlight: Emory University Hospital cardiac cath lab. Cath Lab Digest, 22(12). Retrieved from http://www.cathlabdigest.com/article/Spotlight-Emory-University-Hospital-Cardiac-Cath-Lab

[About Florida]. Egolf, B. (2011, Sept.). Florida Hospital. Cath Lab Digest, 19(9). Retrieved from http://www.cathlabdigest.com/articles/Florida-Hospital

[About Mercy]. Hutchison, L.M., and Myears, D.W. (2012, Oct.). Spotlight interview: Mercy Springfield. Cath Lab Digest. 20(10). Retrieved from http://www.cathlabdigest.com/articles/Spotlight-Interview-%EF%BB%BFMercy-Springfield

[About Parkland]. Eagle, A. (2015, Sept.). Minutes count: Designs that improve ED performance. Health Facilities Management, 28(9), 16-21. Retrieved from http://www.hfmmagazine.com/display/HFM-news-article.dhtml?dcrPath=/templatedata/HF_Common/NewsArticle/data/HFM/Magazine/2015/Sept/hfm-emergency-department-designs-improving-emergency-department-design

[About St. Agnes]. (2015, Aug.). Spotlight: Saint Agnes Medical Center. Cath Lab Digest23(8). Retrieved from http://www.cathlabdigest.com/article/Spotlight-Saint-Agnes-Medical-Center

[About University Health System]. Espanto, F.D. (2007, June). University Health System. Cath Lab Digest. 15(6). Retrieved from http://www.cathlabdigest.com/articles/University-Health-System  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

OPERATING ROOMS: Planning tips for hybrid ORs

Here are some of the considerations / recommendations in planning a hybrid operating room, which integrates imaging equipment into the operating room, based on comments of a steering committee responsible for developing an exhibit at an upcoming national conference:

  • Physician champions are needed
  • Turf issues as far as who controls the hybrid OR must be worked out
  • It takes about a year in planning time
  • Multi-disciplinary hybrid OR steering committee should meet every 2 to 3 weeks
  • 1,200 sf should be adequate for the hybrid OR and the control room
  • The hybrid OR should be part of the surgical suite and close to blood bank

Source: Wood, E. (2015, Sept.). Learn from hybrid OR experts at annual conference Town Hall. OR Manager, 31(9), 1, 7-9.  http://www.ormanager.com/learn-hybrid-experts-annual-conference-town-hall/  Posted by AHA Resource Center (312) 422-2050 rc@aha.org

OPERATING ROOMS: 60 percent of margin comes from perioperative services at better performing hospitals

These statistics come from the consulting firm Surgical Directions:

  • Over 68 percent of revenue comes from perioperative services at better-performing hospitals
  • 60 percent of margin from perioperative services at these better-performing hospitals

Most of this article is about tackling the challenge of staffing the surgical suite.  The consultants recommend establishing a SURGICAL SERVICES EXECUTIVE COMMITTEE (SSEC), which should include surgeons, nurses, hospital executives, and anesthesia providers.  The specific responsibilities of the SSEC are itemized.  It is recommended that the SSEC have a huddle each day to plan for surgical cases scheduled to take place over the next 3 to 5 days.  The OR staffing tool developed by the firm is also described.

Source: Mathias, J.M. (2015, Aug.). Predictive modeling helps match resources with needs. OR Manager, 31(8), 1, 7-9. Retrieved from http://www.ormanager.com/predictive-modeling-helps-match-resources-with-needs/ Posted by AHA Resource Center (312) 422-2050, rc@aha.org


TRENDS: National health expenditures $3.2 trillion in 2015

Total national health expenditures are expected to grow from $3.2 trillion in 2015 to $5.4 trillion in 2024, according to projections prepared by the Centers for Medicare and Medicaid Services.  Federal government economists expect that the annual growth in national health expenditures will be 5.3 percent this year, increasing to 6.2 percent in 2024.  Another often cited metric, national health expenditures as a percent of the gross domestic product (GDP) is expected to increase from 18 percent in 2015 to 19.6 percent in 2024.


U.S. Centers for Medicare and Medicaid Services. (2015, July 30). National health expenditure data: Projected. Retrieved from https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nationalhealthaccountsprojected.html

Keehan, S.P., Cuckler, G.A., and others. (2015, Aug.). National health expenditure projections, 2014-24: Spending growth faster than recent trends. Health Affairs, 34(8), 1407-1417. Retrieved from http://content.healthaffairs.org/content/early/2015/07/15/hlthaff.2015.0600.abstract  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

CODE SILVER: Plan for hospital active shooter event

The typical response time for police to arrive on the scene of an active shooter event is 5 to 7 minutes after the first shots are fired.  Hospitals should think through these crucial first minutes and train staff in passive and active countermeasures before law enforcement arrives.  Passive countermeasures include identification of sanctuary protect-in-place rooms that can be secured.  Employees should also be trained on active countermeasures that can be taken if a shooter enters the room.  This pragmatic article discusses these possible countermeasures.

Where Do Hospital Shootings Occur?

  • 29 percent in the emergency department
  • 23 percent in the parking lot
  • 19 percent in patient rooms

What is a “Zero Incidents Philosophy”?

In a companion article (Sawyer, 2015), the components of violence prevention are itemized, including warning signs.  This zero incidents plan includes a proactive domestic violence component.


Putnam, J., and Losefsky, W. (2015). The first five to seven minutes! Journal of Healthcare Protection Management, 31(2), 10-14; and, Sawyer, J.R. (2015). How to avoid having to “run-hide-fight.” Journal of Healthcare Protection Management, 31(2), 15-22.  This journal has a website, but articles are not directly for sale on it: http://www.iahss.org/?page=Journal  Posted by AHA Resource Center (312) 422-2003, rc@aha.org


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