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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