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

 

EMERGENCY: Which patients are likely to benefit the most from emergency care?

…we identified 51 condition groups most sensitive to emergency care, conditions where timely, high-quality emergency care is expected to make an impact on mortality and morbidity.”

A comprehensive list of emergency care sensitive conditions (ECSC) developed by an expert panel to represent adult patient conditions that are most appropriate for emergency care is the focus of this research article.  The conditions were then paired with national ED utilization data.  There were about 16 million (14 percent) of the roughly 114 million total ED visits in 2016 that were considered to be ECSC.  Here are the utilization data for the top 5 most frequent of these ECSC visits:

• 10.7 percent of all ECSC visits were related to sepsis and SIRS
•   7.9 percent were related to pneumonia
•   7.9 percent were related to chronic obstructive pulmonary disease
•   6.1 percent were related to asthma
•   5.7 percent were related to heart failure

You can also determine those conditions that are most likely to be admitted after presenting in the ED.  Here are the 5 highest:

• 94.8 percent of patients with sepsis and SIRS were admitted
• 88.1 percent with respiratory failure
• 83.9 percent with femur fractures
• 80.0 percent with cerebral infarction
• 79.7 percent with meningitis

Other patient disposition data and median emergency department charges are also included.

Source: Vashi, A.A., and others. (2019, August 7). Identification of emergency care-sensitive conditions and characteristics of emergency department utilization. JAMA Network Open, 2(8).  Click here for free full text:  https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2747479 Posted by AHA Resource Center (312) 422-2003 rc@aha.org

READMISSIONS: 7-day and 30-day rates for U.S., 2014

In 2014, the U.S. 7-day readmission rate was 5 percent and the 30-day rate was 14 percent, according to this new report released by the U.S. Agency for Healthcare Research and Quality (AHRQ).  The data are derived from the Healthcare Cost and Utilization Project (HCUP) and are based on all-payer data – not limited to Medicare data.

This Statistical Brief provides data on the most frequent causes of readmission at both of those points in time.  The most frequent causes are similar at 7 days and at 30 days.  Here is the list for 7-day readmissions, in rank order:

1. Schizophrenia and other psychotic disorders (9 percent)
2. Alcohol-related disorders (7.5 percent)
3. Congestive heart failure, nonhypertensive (7.4 percent)
4. Heart valve disorders (7.3 percent)
5. Hypertension with complications, secondary hypertension (7.2 percent)

Here is the list for 30-day readmissions, in rank order:

1. Congestive heart failure (23.2 percent)
2.  Schizophrenia and other psychotic disorders (22.9 percent)
3. Respiratory failure; insufficiency; arrest, adult (21.6 percent)
4. Alcohol-related disorders (21.5 percent)
5. Deficiency and other anemia (21.2 percent)

This report also provides a breakout of the most common causes of readmission by payer type (Medicare, Medicaid, private insurance and uninsured).

Note: These readmission rate percents represent readmissions per 100 index inpatient stays.

Source: Fingar, K.R., Barrett, M.L., and Jiang, H.J. (2017, October). A comparison of all-cause 7-day and 30-day readmissions, 2014. Statistical Brief, 230.  Click here for free full text: https://www.hcup-us.ahrq.gov/reports/statbriefs/sb230-7-Day-Versus-30-Day-Readmissions.jsp  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

 

ANTIMICROBIAL STEWARDSHIP: Staffing ratio for hospitals

The recommendation for staffing of a comprehensive antimicrobial stewardship program in a hospital setting was developed based on a study done in 12 Veterans Health Administration hospitals.  The recommended staffing guideline is:

• 1 FTE pharmacist per 100 occupied beds

Source: Echevarria, K., and others. (2017, November). Development and application of an objective staffing calculator for antimicrobial stewardship programs in the Veterans Administration. American Journal of Health-System Pharmacy. 74(21), 1785-1790. Click here for publisher’s website: http://www.ajhp.org/content/74/21/1785.long  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

SAFETY: falls and pressure ulcers by type of hospital unit

Development of a hospital quality improvement measure that evaluates patient falls and pressure ulcers was the focus of this study based on 2013 data from the National Database of Nursing Quality Indicators.  Table 2 has interesting unit-level data for different types of hospital patient care units based on statistics supplied by 857 hospitals.  The different types of patient care units compared included: critical care, step-down, medical, surgical, med-surg, rehab and critical access.  The group of hospitals in this study is said to under-represent small hospitals.

Highest and Lowest Rates by Type of Hospital Unit

• 6.09 total falls / 1000 patient days in rehab units – critical care units had the lowest falls rate (1.13 per 1000)
• 6.42 percent of patients in critical care units had hospital acquired pressure ulcers – critical access hospitals had the lowest occurrence – at 1.52 percent
• 17.36 percent of patients in critical care units had restraints – critical access hospitals had the lowest rate at 0).

Source: Boyle, D.K., and others. (2017). A pressure ulcer and fall rate quality composite index for acute care units: A measure development study. International Journal of Nursing Studies. 63, 73-81.  Click here: http://www.journalofnursingstudies.com/article/S0020-7489(16)30146-8/pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

OPERATING ROOMS: Staff turnover rates, U.S. 2017

Staff turnover rates in U.S. hospitals have remained about the same for the past few years, according to this survey conducted in the spring of 2017.  A total of 338 responses were received from OR managers.  Here are the findings for turnover:

• 9.7 percent (average turnover rate for RNs in the OR)
• 8.2 percent (average turnover rate for surgical technologists)

Staff turnover in this survey was defined as “the percentage of staff who have left and been replaced in the past 12 months).

Source: Saver, C. (2017, September). Survey: Surgical volume creeps up amid scramble for new staff. OR Manager, 33(9), 1, 9-11, 13.  Click here for publisher’s website: http://www.ormanager.com/survey-surgical-volume-creeps-up-amid-scramble-for-new-staff/  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

BENCHMARKS: Physicians per major gift officer

…each one-year increment of greater experience was associated with an additional $69,000 in donations per year…”

Finding quantitative data on major gift officers – and their workload – in the literature is unusual.  This study is based on a 2015 survey of seven academic medical centers.  The researchers had hoped to arrive at an optimal workload ratio, but although they found an average of just under 48 faculty physicians per major gift officer, they do NOT consider this average to be an optimal figure.  They did find a statistically significant relationship between a major gift officer’s experience and the amount of donations – as noted in the quote above – highlighting the not surprising importance of retaining staff who are experienced in fundraising.

Source: Wheeler, J.L., et al. (2017, Spring). How many physicians per gift officer? Healthcare Philanthropy Journal, 46(1), 26-32.  Click here for publisher’s website: https://www.ahp.org/Home/Resources_and_Tools/Journal/Home/Resources_and_Tools/Healthcare_Philanthropy_Journal.aspx?hkey=9d23727d-f194-43c6-85e2-cd1e6888419b   Posted by AHA Resource Center (312) 422-2050 rc@aha.org

 

CARDIOLOGY: Higher volume linked to better outcomes

We demonstrate through a large regional database a positive relationship between volume and outcomes in interventional cardiovascular care.”

The volume-outcome relationship in health care has been studied quite a bit over the years – particularly related to various surgical specialties.  It is intuitively pleasing to think that if a surgeon, if a surgical team, if a hospital has a higher volume of … whatever… there will be better outcomes than providers who only see patients of this type now and then.  This study confirms this relationship for heart attack patients who were treated in the interventional cath lab.

The study analyzed outcomes data for 9,360 patients in the Dallas metro area who received care from 2010 to 2015.  Interestingly, for these patients who were diagnosed as having the most severe type of heart attack, 59 percent of patients arrived at the hospital either by themselves or transported by a family member; 39 percent arrived by ambulance.

Mortality in the facilities classified as low volume (less than 200 percutaneous coronary intervention procedures per year) was 9.55 percent.  Mortality in the intermediate and high volume facilities was almost identical – at 6.25 and 6.22 percent, respectively.

Source: Langabeer, J.R., Kim, J., and Helton, J. (2017, July-September). Exploring the relationship between volume and outcomes in hospital cardiovascular care. Quality Management in Health Care, 26(3), 160-164.  Click here for publisher’s website http://journals.lww.com/qmhcjournal/pages/articleviewer.aspx?year=2017&issue=07000&article=00006&type=Abstract    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

EMERGENCY DEPARTMENTS: New capacity metric finds 6 ED beds per 10,000 ED visits in California hospitals

Our novel metrics capturing both supply of beds and visit demand demonstrate that recent trends of hospital supply may be insufficient to keep pace with growing ED patient demand and evolving, complex medical conditions.”

The change in supply of emergency department facilities and in demand for emergency care in California hospitals from 2005 to 2014 was studied using data from the California Office of Statewide Health Planning and Development (OSHPD).  The total number of ED visits in California increased by about one-third over this ten-year period, reaching a total of over 13 million visits in 2015, or 342 ED visits/1,000 population.  The number of emergency departments in California remained about the same – 339 facilities in 2014 – but the number of ED beds increased about 30 percent to 7663 in 2014.

The researchers developed a new metric – ED bed supply per ED visit.  Over the ten-year study period, there was a small decrease of about 4 percent in this metric.  It was roughly 6 ED beds per 10,000 ED visits in both 2005 and 2014.

Sources:

Chow, J.L., Niedzwiecki, M.J., and Hsia, R.Y. (2017, May 11). Trends in the supply of California’s emergency departments and inpatient services, 2005-2014: A retrospective analysis. BMJ Open, 7(5).  Click here for free full text: http://bmjopen.bmj.com/content/bmjopen/7/5/e014721.full.pdf

For more information on OSHPD data, click here: https://www.oshpd.ca.gov/HID/

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