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DISASTER PLANNING: What is hospital reverse triage?

With consideration of multiple strategies, pediatric hospital surge capacity may be considerably more robust than currently appreciated.

In a disaster situation, there is the need to free up space in hospitals to care for newly injured patients.  Reverse triage provides a way to estimate how much capacity might be made available by discharging inpatients earlier than had been planned.  This study, conducted at Johns Hopkins Hospital, studied pediatric patients during the period December 2012 through December 2013 to model the extent of possible reverse triage. The researchers found that using reverse triage as well as all other possible strategies to increase capacity could free up over 50 percent of capacity nearly immediately and 84 percent by the fourth day of a disaster.  Most of the pediatric patients who were considered appropriate for early discharge were in the child and adolescent psychiatric unit.

Source: Kelen, G.D., and others. (2017, February 6). Effect of reverse triage on creation of surge capacity in a pediatric hospital. JAMA Pediatrics. Click here: https://www.researchgate.net/profile/Gai_Cole/publication/313361752_Effect_of_Reverse_Triage_on_Creation_of_Surge_Capacity_in_a_Pediatric_Hospital/links/589cce42a6fdcc3e8bea401c/Effect-of-Reverse-Triage-on-Creation-of-Surge-Capacity-in-a-Pediatric-Hospital.pdf

EDs: What markets are more likely to have freestanding emergency departments [FSEDs]?

For hospital administrators, this research suggests that FSEDs are a practical strategic tool for expanding markets.”

Characteristics of health service areas in which hospitals are more likely to offer freestanding emergency departments (FSEDs) were studied based on data from 14 states during the period 2002 to 2011.

Market Characteristics: More Likely to Find FSEDs

  • Higher income
  • Younger and growing population
  • More specialists
  • More intense competition
  • Presence of other freestanding emergency departments
  • Higher market penetration rates for Medicare managed care

The study also drew conclusions about the characteristics of hospitals that are more likely to provide freestanding emergency departments.

Source: Patidar, N., and others. (2017, July-September). Contextual factors associated with hospitals’ decision to operate freestanding emergency departments. Health Care Management Review, 42(3), 269-279. Click here for publisher’s website http://journals.lww.com/hcmrjournal/Abstract/2017/07000/Contextual_factors_associated_with_hospitals_.9.aspx  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

BENCHMARKING: Housekeeping cost per square foot

The relationship between patient satisfaction with care received in the hospital, as measured by the Medicare star ratings, and housekeeping cost was studied based on data from nearly 3,500 hospitals.  The authors of this very brief report note that the findings are intuitive – spend more money on housekeeping and patients will be more satisfied –  except for the oddly low cost per square foot for the 5-star rated hospitals.  Here are some of the reported findings:

Housekeeping Cost per Patient Day: 5-star is the best rating

  • $174.98 for 5-star rated hospitals
  • $103.82 for 4-star rated hospitals
  • $  85.16 for 3-star rated hospitals
  • $  75.98 for 2-star rated hospitals
  • $  75.93 for 1-star rated hospitals

Housekeeping Cost per Square Foot: 5-star is the best rating

  • $2.80 for 5-star rated hospitals
  • $6.73 for 4-star rated hospitals
  • $4.96 for 3-star rated hospitals
  • $3.83 for 2-star rated hospitals
  • $4.34 for 1-star rated hospitals

Source: The importance of a clean hospital room, according to patients. (2017, April). Healthcare Financial Management, 71(4), 78-79.  Click here for publisher’s website: https://www.hfma.org/Content.aspx?id=53567    Posted by AHA Resource Center (312) 422-2050, rc@aha.org

PHYSICIANS: Average salary offers to recruited specialists

For the eleventh consecutive year, family physicians topped the list of Merritt Hawkins’ 20 most requested recruiting assignments, underscoring the continued urgent demand for primary care physicians in an evolving healthcare system.”

Each year, the physician recruiting firm Merritt Hawkins provides aggregate data based on the many recruiting assignments completed during the previous year.  The data in this report cover nearly 3,300 search assignments from the first quarter 2016 to the first quarter 2017.

RECRUITING OFFERS:  Base Salary / Guaranteed Income (average) [Excludes production bonus; excludes benefits]

  • $120,000 Physician assistant
  • $123,000 Nurse practitioner
  • $231,000 Family Medicine
  • $240,000 Pediatrics
  • $257,000 Internal Medicine
  • $263,000 Psychiatry
  • $264,000 Hospitalist
  • $305,000 Neurology
  • $335,000 Obstetrics/Gynecology
  • $349,000 Emergency Medicine
  • $376,000 Anesthesiology
  • $390,000 Pulmonology/Critical Care
  • $411,000 General Surgery
  • $421,000 Dermatology
  • $428,000 Cardiology (non-invasive)
  • $436,000 Radiology
  • $468,000 Otolaryngology
  • $492,000 Gastroenterology
  • $563,000 Cardiology (invasive)
  • $579,000 Orthopedic Surgery

Source: Merritt Hawkins (2017). 2017 review of physician and advanced practitioner recruiting incentives.  Dallas: MH.  Click here: https://www.merritthawkins.com/physician-compensation-and-recruiting.aspx  Posted by AHA Resource Center (312) 422-2050 rc@aha.org

NICUs: What is a small baby unit?

Small baby units take the neonatal intensive care unit (NICU) concept to a new level by specializing in the care of the smallest babies – known as micro-preemies – born at fewer than 27 weeks gestation and/or weighing less than 1,000 grams (2.2 pounds).  The design of the units, which are part of a larger NICU, includes providing a dark, quiet environment.  Parents are encouraged to participate in skin-to-skin care (SSC) techniques that fosters bonding, such as Kangaroo Mother Care.  Caregivers are teamed up to deliver two-person care when the micro-preemies need to be touched.  As the babies grow, they may be transitioned out of the small baby unit to the NICU.

Hospitals with Small Baby Units (this is not a comprehensive list)

  • Advocate Lutheran General Hospital (Park Ridge, IL)
  • Children’s Hospital (Orange, CA)
  • Greenville Health System (Greenville, SC)
  • Helen Devos Children’s Hospital (Grand Rapids, MI)
  • Mercyhealth Hospital-Rockton Avenue (Rockford, IL)
  • Nationwide Children’s Hospital (Columbus, OH)

Sources:

Gonya, J., and others. (2017). Investigating skin-to-skin care patterns with extremely preterm infants in the NICU and their effect on early cognitive and communication performance: A retrospective cohort study. BMJ Open, 7.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5372108/pdf/bmjopen-2016-012985.pdf

GHS launches NICU small baby unit. (2017, May 12). WSPA-TV. http://wspa.com/2017/05/12/ghs-launches-nicu-small-baby-unit/

Jackson, A. (2015, December 9).  Born at 25 weeks weighing less than 2 pounds, ‘spunky’ girl survives in small baby unit. MLive. http://www.mlive.com/news/grand-rapids/index.ssf/2015/12/small_baby_nicu_at_devos_child.html

Morris, M., Cleary, P., and Soliman, A. (2015, October). Small baby unit improves quality and outcomes in extremely low birth weight infants. Pediatrics, 136(4).  http://pediatrics.aappublications.org/content/pediatrics/136/4/e1007.full.pdf

Watley, K. (2017, February 6). Mercyhealth in Rockford opens region’s first small baby unit to care for micro-preemies. https://mercyhealthsystem.org/mercyhealth-opens-small-baby-unit-rockford/

Woloshyn, E. (2017, April 20). Special unit mimics mother’s womb. Health enews.

http://www.ahchealthenews.com/2017/04/20/special-unit-mimics-mothers-womb/  Posted by AHA Resource Center (312) 422-2050 rc@aha.org

POPULATION HEALTH: 678,383 ESRD patients in US (2014)

Each year, there are about 120,000 patients newly diagnosed with end stage renal disease (ESRD) and this number has been rising steadily.  Here are the exact counts of incidence – that is, new cases treated in the U.S.:

  •   77,018 new ESRD cases in 1996
  •   94,662 new cases in 2000
  • 106,662 new cases in 2005
  • 115,920 new cases in 2010
  • 120,688 new cases in 2014

The prevalence of end stage renal disease – the total number of patients who are living with the disease at any given point in time – has more than doubled during the 1996 to 2014 time period.  Here are the exact prevalence counts:

  • 303,311 total ESRD cases in 1996
  • 390,158 total cases in 2000
  • 484,935 total cases in 2005
  • 591,776 total cases in 2010
  • 678,383 total cases in 2014

What kind of treatment do ESRD patients receive?

Looking at the entire population of patients with end stage renal disease, about two-thirds are on hemodialysis – usually received in a dialysis center.   Another seven percent are on peritoneal dialysis.  The balance (30 percent) have received a kidney transplant.  These percentages are based on 2014 data.

Geographic differences

There are substantial differences in the incidence of kidney failure in different parts of the country.  Areas with the highest rates of new end stage renal disease patients include Texas and Southern California, while New England states have the lowest rates.

Source: United States Renal Data System. (2016). Incidence, prevalence, patient characteristics, and treatment modalities. In Annual data report 2016: Epidemiology of kidney disease in the United States. (Vol. 2, Chapt. 1). Ann Arbor, Michigan: USRDS Coordinating Center. Click here for free full text https://www.usrds.org/adr.aspx  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

 

CANCER: 5-year survival rate improves in recent decades

Survival improved substantially over this time period for both whites and blacks overall (all sites) and for almost all cancer types…”

The overall five-year survival rate for cancer patients has improved in the past 40 years, according to national data in this fact-packed, scholarly article.

Looking at the more treatable cancers, here are the top five with the highest survival rates, based on recent data:

  • Prostate (99.3 percent five-year survival rate)
  • Thyroid (98.3 percent)
  • Skin (93.2 percent)
  • Breast (90.8 percent)
  • Uterine (83.4 percent)

Source: Jemal, A., and others. (2017). Annual report to the nation on the status of cancer, 1975-2014, featuring survival. Journal of the National Cancer Institute, 109(9).  Click here for free full text: https://academic.oup.com/jnci/article-lookup/doi/10.1093/jnci/djx030  Posted by AHA Resource Center (312) 422-2050 rc@aha.org