OPERATING ROOMS: How Mass General ramped up again after procedures were deferred during early days of pandemic

During the early days of the pandemic, hospitals were asked to defer non-essential surgery to free up resources for the care of SARS-CoV2 patients. Within 4 weeks, Massachusetts General Hospital (Boston) had deferred 6,500 surgical procedures – dropping to 15 percent of previous surgical volume. How the hospital devised an orderly methodology to triage surgical patients who were waiting to be rescheduled is described. This safe and swift methodology allowed the hospital to ramp back up from 10 to 58 operating rooms running each day – at 750 cases per week, a full schedule. How surgeons were assigned time as capacity changed is also discussed.

Source: Brumit, R. and others. Recovering an Operating Room Schedule During a Global Pandemic: A Method for Safe and Swift Increases in OR Volume During Times of Crisis. Journal of Medical Systems 45(12). Full text free here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7787880/pdf/10916_2020_Article_1687.pdf

PATIENT READMISSION: Home visits help post-discharge

Adult patients discharged from hospitals in the Cleveland Clinic Health System who were thought to be at high risk of readmission were studied. These patients were offered different combination of home visits made by advanced practice nurses and/or paramedics. No significant difference was found with 90-day readmissions, 180-day readmissions, emergency visits or patient mortality, but the 30-day readmission rate was lower in the study group compared to a matched group that did not receive the home visits.

Source: Anita D. Misra-Hebert, and others. “Healthcare utilization and patient and provider experience with a home visit program for patients discharged from the hospital at high risk for readmission.” Healthcare 9(1) (Mar. 2021). Full text free here: https://www.sciencedirect.com/science/article/pii/S2213076420301172

AMBULATORY CARE: How time of day affects quality of care and what to do about decision fatigue

Quality of care deteriorates over the course of the day due to the combination of shared cognitive biases, hurried visits, and mounting decision fatigue…”

Studies show that the quality of outpatient care decreases over the course of the clinic day. Patients seen later in the day are likely to have fewer appropriate services ordered and, also, more low-value inappropriate services ordered. A difference in diagnostic accuracy has also been found based on time of day. How to counteract this time-of-day trend by incorporating alerts into the electronic health record, by using social norm interventions, by optimizing use of telehealth and mail, and by changing payment models are discussed.

Source: Allison H. Oakes, and Mitesh S. Patel. “Time to Address Disparities in Care by Appointment Time.” Healthcare 9(1), (Mar. 2021). https://www.sciencedirect.com/science/article/pii/S2213076420301068

ORGANIZATIONAL INNOVATION: McKinsey consultants forecast what pandemic-driven change will look like

Business leaders tell us that the metabolic rate of their organizations has soared. Their companies have accelerated by adopting new ways to work.”

How much and in what ways will the pandemic push companies to adopt Silicon Valley-inspired nimble organizational concepts? What will the agile operational model look like in the near term? McKinsey thought leaders focus on change accelerations brought on by the pandemic and how things are changing more quickly than had been thought possible. A key set of three steps should be employed: to reflect, decide and then deploy at scale. Learnings from the pandemic will help organizations position themselves for greater uncertainty in the future.

Jost, Gregor, and others. “How COVID-19 is redefining the next-normal operating model.” The McKinsey Quarterly 1 (2021). Full text free here: https://www.mckinsey.com/business-functions/organization/our-insights/how-covid-19-is-redefining-the-next-normal-operating-model

POPULATION HEALTH: County Health Rankings adapted to be used nationally

The County Health Rankings program, in existence since 2002, provides an annual look at how well counties within a given state are doing on health indicators compared to other counties in the same state. There are currently over 3,000 counties participating. The purpose of this study, funded by Kaiser Permanente, Oakland, CA, was to adapt the original methodology so that counties could be compared nationally, not just within state. Data from Kaiser Permanente’s Community Health Report are included to illustrate the metrics that are included. Two national maps showing county comparisons are also included.

Stiefel, Matthew C., and others. “Using the County Health Rankings Framework to Create National Percentile Scores for Health Outcomes and Health Factors.” The Permanente Journal 25 (Winter 2021). Full text free: http://www.thepermanentejournal.org/files/2020/tpj20012.pdf

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COVID-19: Rural Federal Resource Guide

This resource matrix organizes funding opportunities identified in the CARES Act and other federal resources that can help support rural America. Opportunities are categorized by customer and assistance type.

USDA and its Federal partners have programs that can be used to provide immediate and long-term assistance to rural communities affected by the COVID-19 outbreak.

These programs can support recovery efforts for rural residents, businesses and communities through:

• Technical training
• Management assistance
• Financial assistance
• State and local assistance

Source: United States Department of Agriculture (USDA), 2020. https://www.rd.usda.gov/sites/default/files/USDA_COVID-19_Fed_Rural_Resource_Guide.pdf?utm_campaign=hsric&utm_medium=email&utm_source=govdelivery

Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

2019 National Health Care Governance Survey Report

A new AHA report provides a wealth of benchmarking data for hospital boards, answering questions about typical size of the hospital board, board diversity, term limits, board selection, orientation/education, evaluation, time commitment, and more.

The report includes data and commentary organized by these categories:

• Board composition
• Board structure and support
• Board practices
• Performance oversight
• Board culture

Source: National health care governance survey report. American Hospital Association, 2019. https://trustees.aha.org/system/files/media/file/2019/06/aha-2019-governance-survey-report_v8-final.pdf

Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

 

AMA Updated Data on Physician Practice Arrangements

Data from the American Medical Association’s Physician Practice Benchmark Surveys indicates for the first time ever that more physicians are employees rather than owners of medical practices. Physician employment has been an ongoing trend in recent years, but the AMA report indicates the pace of growth has slowed.

This latest report provides data and discussion of medical practices, covering their number, type, size, specialty, and ownership structure.

Source: Kane CK. Policy research perspectives. Updated data on physician practice arrangements: for the first time, fewer physicians are owners than employees. American Medical Association, 2019. https://www.ama-assn.org/system/files/2019-07/prp-fewer-owners-benchmark-survey-2018.pdf 

Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

 

2017 National Nursing Workforce Survey

The National Council of State Boards of Nursing and the National Forum of State Nursing Workforce Centers have published their latest joint biennial survey results on the nation’s nursing workforce. The report provides a statistical overview and discussion of both registered nurses [RN] and licensed practical/vocational nurses [LPN/LVN]. Survey findings cover these topics:

• Size of the RN and LPN/LVN workforce nationally and by state
• Aging of the workforce
• Gender, race, and ethnic diversity
• Education
• Employment and salary
• Telehealth use

Source: Smiley RA and others. The 2017 national nursing workforce survey. Journal of Nursing Regulation 9(3):S1-S88, Oct. 2018, updated Jan. 2019. https://www.journalofnursingregulation.com/article/S2155-8256(18)30131-5/fulltext

Posted by AHA Resource Center, (312) 422-2050, rc@aha.org

PATIENT FALLS: Canadian study evaluates rubber flooring in long-term care setting

Falls are a major health concern for older adults world-wide, particularly in long-term care (LTC), where approximately 60% of residents fall at least once per year, and 30% of falls cause injury…”

The value of installing a synthetic rubber flooring (compliant flooring) over a concrete floor was compared to plywood over concrete in this randomized trial conducted at one long term care facility in British Columbia.  There were 74 private rooms in the intervention group and 76 in the control group in this 4-year study.  The researchers concluded that the rubber flooring was “not effective for preventing serious fall-related injuries in LTC.”  This article includes interesting tables showing details about the nearly 2,000 patient falls recorded over a 4-year period in this one Canadian facility.  The vast majority of falls occurred in the patient room (excluding the bathroom).  Falls were most likely to occur in the evening and least likely to occur in the afternoon.  There were 85 falls resulting in serious injury,

Source: Mackey, D.C., and others. (2019, June 24). The Flooring for Injury Prevention (FLIP) study of compliant flooring for the prevention of fall-related injuries in long-term care: A randomized trial. PLoS Medicine, 16(6).  Click here for free full text:  https://journals.plos.org/plosmedicine/article/file?id=10.1371/journal.pmed.1002843&type=printable  Posted by AHA Resource Center (312) 422-2050, rc@aha.org