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MAGNET HOSPITALS: How did the idea come about?

During the nursing shortage of the early 1980s, there were an estimated 100,000 vacancies nationwide and inadequate staffing in over three-quarters of U.S. hospitals.  In an effort to alleviate the shortage, the American Academy of Nursing engaged four AAN fellows to choose a topic and conduct research on nurses employed at hospitals.  The author of this brief article – Muriel Poulin – and her colleagues Margaret McClure, Margaret Sovie and Mabel Wandelt, decided to study the characteristics of hospitals that were doing a good job of retaining nursing staff.  They surveyed 41 hospitals and prepared a report that served as the basis of the later Magnet Recognition Program.

When I stop to consider how much the program has progressed, I cannot get over it.  It has been a remarkable evolution that now includes hundreds of healthcare organizations around the world…” (Dr. Poulin, page 73).

Sources:

Poulin, M. (2017, February). A remarkable journey: Why the Magnet Recognition Program continues to resonate today. JONA. The Journal of Nursing Administration, 47(2), 72-73. Click here for publisher’s website: http://journals.lww.com/jonajournal/Abstract/2017/02000/A_Remarkable_Journey__Why_the_Magnet_Recognition.2.aspx

American Nurses Credentialing Center. (2017). ANCC Magnet Recognition Program. Click here: http://www.nursecredentialing.org/Magnet  Posted by AHA Resource Center (312) 422-2003 rc@aha.org

VIOLENCE: Top 5 reasons why guns are fired in hospitals

These data were compiled based on reports of firearm discharges in hospitals over a 10-year period ending in December 2016.  During this time, a total of 416 firearm discharges occurred, killing 279 people.  A tendency for larger hospitals to have more frequent firearm discharges was observed.

Top 5 Motives for Firearm Discharge

  • 30 percent (suicide)
  • 15 percent (while violating another law)
  • 10 percent (domestic – family dispute)
  • 10 percent (related to care of patient who is a prisoner)
  •   6 percent (accidental)

Elderly people (over 70 years old) are disproportionately likely to be in this offender group.

Source: Aumack, T., York, T., and Eyestone, K. (2017). Firearm discharges in hospitals: An examination of data from 2006-2016. Journal of Healthcare Protection Management, 33(1), 1-8.  Click here for publisher’s website: http://www.iahss.org/?page=Journal  Posted by AHA Resource Center (312) 422-2050 rc@aha.org

ISOLATION ROOMS: How many air changes per hour?

Design considerations for negative isolation and positive isolation rooms are discussed in this brief article by an engineering consultant.  Negative-pressure isolation rooms are intended to keep an infectious patient from infecting others in the hospital.  Positive isolation rooms are the opposite – intended to keep germs away from an immunocompromised patient in the room.  The recommendation for both types of isolation rooms is reported to be at least 12 air changes per hour.  Some hospitals use isolation rooms for general patients when they are available.  Although allowed in the past, it is no longer possible to operate isolation rooms that can be switched back and forth from negative to positive pressure.

Source: Herrick, M. (2017, February). Pressure points: Planning and maintaining air isolation rooms. Health Facilities Management, 30(2), 29-32.  Click here: http://www.hfmmagazine.com/articles/2671-planning-and-maintaining-hospital-air-isolation-rooms  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

SPACE PLANNING: How to determine number of ORs needed

Tips for the planning process for a new surgical suite are given in this brief newsletter article by an experienced health care architect.  There are some interesting facts that are otherwise difficult to find in the literature:

  • What is the difference between an operating room and a procedure room?
  • What is a hybrid operating room?
  • How are some of the metrics used defined – room time, room turnaround time, throughput?
  • What is a target room turnaround time? (“…usually 15 to 20 minutes”)
  • How many hours are procedure rooms open? (“Most procedure rooms are available eight hours per day for a total of 480 minutes per day”)

Scheduling efficiency: A scheduling efficiency factor is multiplied by the annual minutes available per procedure room to account for periods of time that a case cannot be scheduled.  This factor may range from 70 percent for ORs or procedure rooms used for complex (and sometimes unscheduled) procedures — such as cardiothoracic, neurosurgery, and trauma/orthopedics — to 90 percent for an outpatient suite where all procedures are scheduled.”  (page 3)

Source:  Hayward, C. (2017, Winter). How many operating rooms? It’s complicated. Click here for newsletter: https://www.spacemed.com/newsletter/news101.html  Posted by AHA Resource Center (312) 422-2050 rc@aha.org

OBSTETRICS: Reasons OB units close in rural areas

The reasons why rural hospitals closed their labor and delivery services were studied based on a telephone survey of hospitals in nine states.  Of the 263 hospitals that responded, 19 (or 7.2 percent) closed their OB units during the study period of 2011 to 2014.  Here are the reasons that were identified as risk factors for closing:

  • Low birth volume
  • Private (as opposed to public) ownership of the hospital
  • Low number of family physicians practicing in the area
  • Low income surrounding area

Source: Hung, P., and others. (2016, August). Why are obstetrics units in rural hospitals closing their doors? HSR. Health Services Research, 51(4), 1546-1560.  Click here for publisher’s website: http://onlinelibrary.wiley.com/doi/10.1111/1475-6773.12441/full  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

READMISSIONS: Continuity of care in 12 months before hospital admission reduces 30-day readmission rate

This study of over 14,000 Mayo Clinic patients cared for under a patient-centered medical home (PCMH) model looked at the concept of visit entropy, which pertains to the degree of what the authors term “disorganization” of patient care.  What this refers to is whether a patient is seen always by the same primary physician (perfect continuity of care) or whether a patient is seen by different physicians on different visits.

Statistics About These Mayo Clinic PCMH Patients

  • 14,662 patients admitted to hospital (and included in this analysis)
  • 11.6 percent readmitted within 30 days
  • 8 outpatient visits (median patient visits in 12 months before hospital admission) – this excludes any ED visits on the day of admission
  • 5 different clinicians seen (median patient during 12 months before hospital admission)

CONCLUSION

Patients with higher [visit entropy] in the 12 months before hospital admission were more likely to be readmitted or die within 30 days of hospital discharge.

Source: Garrison, G.M., and others. (2017, January-February). Visit entropy associated with hospital readmission rates. Journal of the American Board of Family Medicine, 30(1), 63-70. Click here for free full text: http://www.jabfm.org/content/30/1/63.full.pdf  Posted by AHA Resource Center (312) 422-2050 rc@aha.org

Average Cost of a Hospital Stay, Emergency Room Visit, Physician or Dental Office Visit, or Home Care Service

In 2014, the mean cost for a hospital stay was $13,450, with an average out-of-pocket expense of $351. That’s according to Medical Expenditures Panel Survey [MEPS] Household Component data available from the Agency for Healthcare Research and Quality.

An emergency room visit averaged $1,048 in 2014, with $95 of that in out-of-pocket expenses.

A hospital outpatient visit expense averaged $927 with a $54 out-of-pocket cost, while an office-based physician visit totaled $222 with $29 out-of-pocket. The mean out-of pocket expense for a dental visit was $132 of the total visit cost of $295.

Finally, home health care expenses averaged $1,454 per month for those who had the expense during the year.

MEPS data on household medical expenditures is also available for earlier years.

Source: Expenditures per event by health care service type. Medical Expenditures Panel Survey, Household Component summary tables, Agency for Healthcare Research and Quality, accessed Feb. 15, 2017 at https://meps.ahrq.gov/mepsweb/data_stats/quick_tables_results.jsp?component=1&subcomponent=0&year=-1&tableSeries=9&searchText=&SearchMethod=1&Action=Search

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