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TURNAROUNDS: How to effect change quickly at a struggling hospital using ‘buddying’ mentoring approach

How a buddying partnership was used to implement a quality improvement initiative at Medway NHS Foundation Trust, a large general hospital located near London, England, is described in this detailed case study.  Medway’s partner in the buddying agreement was Guys and St. Thomas’ Hospitals Hospital NHS Foundation, which provided “advice, operational assistance, ‘compassionate’ leadership and pastoral staff…”  This team approach was successful in quickly improving patient throughput issues.

Source: Leach, R., Banerjee, S., Beer, G., and others. (2019). Supporting a hospital in difficulty: Experience of a ‘buddying’ agreement to implement a new medical pathway. Future Healthcare Journal, 6(1), 67-75. Click here for full text:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6520082/pdf/futurehealth-6-1-67.pdf  Posted by AHA Resource Center (312) 422-2050,  rc@aha.org

MODELS OF CARE: Geographic unit-based teams case study

Redesign of the care model for inpatient units at Brooklyn Hospital Center (NY, 464 beds)  is described in this article.  Previously, hospital medicine teams would round on patients scattered about the hospital.  After the redesign, geographic unit-based teams were created.  How staff handled the transition to the new model and interactions with the bed board system are discussed.  Workstations on wheels (WOWs) were added to rounds.  Provider and patient satisfaction were found to improve after implementation of the new model.

Source: Pendharkar, S., Malieckal, G., and Gasperino, J. (2019, May 10). Unit-based models of care. The Hospitalist.  Click here for full text:  https://www.the-hospitalist.org/hospitalist/article/200713/mixed-topics/unit-based-models-care  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

DISRUPTORS: Redesigning patient care in a ‘facilitated self-service’ model – the bot, the nurse, the PCP

Facilitated self-service means consumers can handle most of their needs without help, but some needs require a higher level of service.

How to redesign care at the physician office visit level is discussed in this brief perspective.  In the facilitated self-service model, patients might first encounter a bot for routine check-ups of chronic conditions.  The second level of care would be the nurse and the third level, the physician, if needed.  The authors maintain that this radically different approach would be better than trying to expand the numbers and availability of primary care physicians for routine care.

Source: Asch, D.A., Nicholson, S., and Berger, M.L. (2019, May 16). Toward facilitated self-service in health care.  New England Journal of Medicine, 380(20), 1891-1893.  Click here for full text (you can sign up as a visitor for 3 full text articles per month):  https://www.nejm.org/toc/nejm/medical-journal?query=main_nav_lgPosted by AHA Resource Center (312) 422-2050 rc@aha.org

PREVENTION: Appointment time of physician office visits found to be associated with getting cancer screening tests

Patients with office visit times later in the clinic day were found to be less likely to receive orders for breast or colorectal screening tests in this study of 33 primary care practice sites.  Additionally, patients with appointments later in the day were found to be less likely to actually have the screening done within the following 12 months.  The authors suggest that as it gets later in the day, physicians may fall behind schedule which may contribute to shorter discussions with patients, among other factors.

Source:  Hsiang, E.Y., Mehta, S.J., Small, D.S., Rareshide, C.A.L., Snider, C.K., Day, S.C., and Patel, M.S. (2019). Association of primary care clinic appointment time with clinician ordering and patient completion of breast and colorectal cancer screening. JAMA Network Open, 2(5).  Click here for full text:  https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2733171  Posted by AHA Resource Center (312) 422-2050 rc@aha.org

 

How many physician office visits in U.S. each year?

In 2016, a total of 883,700,000 visits were made to office-based physicians in the U.S., according to newly released federal government estimates.  This represents 278 visits per 100 persons in the U.S.  Not surprisingly, children under one year old and the elderly had higher physician office visit rates than patients of other ages.  The payer mix for physician office visits was found to be:

  • 54 percent private insurance
  • 26 percent Medicare
  • 15 percent Medicaid
  •   3 percent no insurance

Source: Characteristics of office-based physician visits, 2016. (2019, January). NCHS data brief. 331. Click here for full text free: https://www.cdc.gov/nchs/data/databriefs/db331-h.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Rural Obstetric Services: Access, Workforce, and Impact

A new research briefing looks at declining access for rural women to obstetric services. Between 2004 and 2014, 179 rural counties in the U.S. lost hospital-based obstetric services, with over half of rural counties now lacking these services. The distribution of rural counties without obstetrics services varies widely geographically, from 78% in Florida to 9% in Vermont.

Access to obstetric service factors may be related to lower birthrates, a limited rural obstetric workforce, Medicaid eligibility, and socio-economic factors. The impact of limited OB services is also briefly covered.

Links to the nine reports covered by the research overview — all from the University of Minnesota Rural Health Research Center — are  provided.

Source: Rural obstetric services: access, workforce, and impact. Rural Health Research Recap, Rural Health Research Gateway, April 2019. https://www.ruralhealthresearch.org/recaps/8

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

OPIOIDS: US fentanyl overdose deaths total 18,335 in 2016

The number of drug overdose deaths involving the synthetic opioid fentanyl has skyrocketed in the six years covered in this federal government report.  Here are the year-by-year counts:

  •   1,663 (2011)
  •   1,615 (2012)
  •   1,919 (2013)
  •   4,223 (2014)
  •   8,251 (2015)
  • 18,335 (2016)

In the most recent year, 2016, the geographic region with the highest number of fentanyl overdose deaths was the Midwest, followed by the MidAtlantic states.

Source: U.S. Department of Health and Human Services, Center for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System. (2019, March 21, rev. April 3). Drug overdose deaths involving fentanyl, 2011-2016. National Vital Statistics Reports, 68(3), 1-18.  Click here for full text:  https://www.cdc.gov/nchs/data/nvsr/nvsr68/nvsr68_03-508.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org