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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

BEST PRACTICES: Implementing a quality improvement bundle for care of high risk infants in the delivery room

This was a case study of 548 high-risk infants born 2010 to 2012 at Palomar Medical Center (Escondido, CA) who were then transferred to the neonatal intensive care unit at Palomar Rady Children’s Hospital (San Diego).  About half of the infants were born before implementation of an quality improvement project intended to standardize delivery room management – a preintervention group.  The merits of each of the changes in practice – such as a significant decrease in intubation – are discussed.  A delivery room checklist is included.

Source: Sauer, C.W., and others. (2016, November 16). Delivery room quality improvement project improved compliance with best practices for a community NICU. Scientific Reports, 6, 37397.  Click here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5116615/pdf/srep37397.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

SURGICAL SUITE: Neurosurgical operating room of the future incorporates aeronautical industry concepts

The next phase of the OR of the future is to focus at the cellular level through next-generation imaging that will allow advanced interrogation of normal and diseased neural tissue…which will be systematically captured in the background, curated, and analyzed by the informatics system.”

How to redesign the neurosurgical operating room to incorporate concepts borrowed, in part, from the aeronautical industry is explored in this scholarly article.  How to improve patient safety by focusing on data collection and on honing the science of surgery is discussed.  This article is based on pioneering work being done at the Aurora Neuroscience Innovation Institute (Milwaukee) in collaboration with vendors Storz Corp., Stryker Corp., Synaptive Medical, and Nico Corp.

Source: Kassam, A.B., and others. (2017, June). The operating room of the future versus the future of the operating room. Otolaryngology Clinics of North America, 50(3), 655-671.  Click here for the publisher’s website: http://www.sciencedirect.com/science/article/pii/S0030666517300166

Here is a link to the Aurora Neuroscience Innovation Institute website: https://www.aurorahealthcare.org/services/neuroscience  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

BENCHMARKS: Space planning in labor and delivery

This is a rule-of-thumb provided by Hayward & Associates, a health care facility planning firm, that may be used to plan for a labor and delivery area.  In the following ratios, LDR means labor-delivery-recovery.  LDRP means the same except adds a postpartum stay in the same room – this is also known as single-room maternity care.

Space planning based on annual births

  • 100 to 200 births / LDRP room if the LDRP concept is used exclusively
  • 300 to 400 births / LDR or LDRP room if some patients are moved to a separate postpartum room after discharge

Recommended departmental gross square feet (DGSF) and departmental gross square meters (DGSM) are also given in this brief article.

Source: Hayward, C. (2017, Spring-Summer). Obstetrical services capacity and preliminary space need. SpaceMed Newsletter. Click here: https://www.spacemed.com/newsletter/rule-102-ob.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

SURGICAL SUITES: Guidelines on best practices to prevent surgical site infections

The number of unresolved issues in this guideline reveals substantial gaps that warrant future research.” (page E6)

Best practices in avoiding surgical site infections were studied by the Centers for Disease Control and Prevention with the assistance of the Healthcare Infection Control Practices Advisory Committee.  This guideline is based on the full text review of nearly 900 journal articles and studies.  The guideline is organized according to specific surgical practices – for example the efficacy of wearing a space suit during orthopedic surgery – and assigns each practice a rating on a continuum as to whether the practice is highly recommended, unresolved, or somewhere in between.  The rating on the space suits, for instance, is that it is unresolved.

Source: Berrios-Torres, S.I., and others. (2017, May 3). Centers for Disease Control and Prevention guideline for the prevention of surgical site infection 2017. JAMA Surgery. Click here: http://jamanetwork.com/journals/jamasurgery/fullarticle/2623725  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

EMERGENCY: Factors involved in multiple ED visits

Patterns of multiple ED visits are likely driven by patients’ health conditions and care needs rather than by PCP-related factors.  Multiple ED visits also appear to be complementary, rather than substitutionary, to physician office visits.  This implies that multiple ED visits are not indicative of discretionary use.  The finding also suggests PCP-focused interventions aimed at reducing ED use are unlikely to have a significant impact.”

This study tackled the question: To what extent could expanded primary care options, such as changing physician office hours, substitute for emergency department care?  The data included records on over 20,000 adult patients of the Geisinger Health Plan (a Danville, PA, HMO) who visited the emergency department more than once a year during the study period 2015 to 2016.  These more frequent emergency department users tended to be younger adults (under 40 years old), Medicaid recipients, and patients with multiple clinical issues.  The more frequent users were also found to be patients with a higher number of primary care visits and inpatient hospital admissions.

Source: Maeng, D.D., Hao, J., and Bulger, J.B. (2017). Patterns of multiple emergency department visits: Do primary care physicians matter? The Permanente Journal, 21, 16-063.  Click here: http://www.thepermanentejournal.org/files/2017/16-063.pdf   Posted by AHA Resource Center (312) 422-2050, rc@aha.org

 

HOSPITALS: How many DSH hospitals are there?

Hospitals that serve a higher proportion of low-income patients are eligible to receive disproportionate share payments from state Medicaid programs.

DSH hospital: A hospital that receives disproportionate share hospital (DSH) payments and meets the minimum statutory requirements to be eligible for DSH payments: a Medicaid inpatient utilization rate of at least 1 percent and at least two obstetricians with staff privileges that treat Medicaid enrollees (with certain exceptions” (page 57)

In this report from the Medicaid and CHIP Payment and Access Commission (MACPAC), there is a table that quantifies the number of disproportionate share hospitals (DSH) in the United States as of 2012.

DSH Hospitals: Counts by Type of Hospital

  • 1,865 (55 percent) of Short-term acute care hospitals
  •    565 (42 percent) of Critical access hospitals
  •    129 (26 percent) of Psychiatric hospitals
  •      47 (58 percent) of Children’s hospitals
  •      32 (  7 percent) of Long-term hospitals
  •      32 (13 percent) of Rehabilitation hospitals

Counts by Location

  • 1,681 (40 percent) of urban hospitals
  •    989 (54 percent) of rural hospitals

Counts by Teaching Status

  • 1,921 (39 percent) of non-teaching hospitals
  •    392 (59 percent) of “low-teaching” hospitals
  •    357 (79 percent) of “high-teaching” hospitals

Source: Medicaid and CHIP Payment and Access Commission. (2017, March). Report to Congress on Medicaid and CHIP (pp. 57, 59). Washington, D.C.: MACPAC.  Click here for access: https://www.macpac.gov/wp-content/uploads/2017/03/March-2017-Report-to-Congress-on-Medicaid-and-CHIP.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org