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EMERGENCY: What is an emergency department-based ICU?

In 2015, the University of Michigan Health System created The Joyce and Don Massey Family Foundation Emergency Critical Care Center (EC3), an ICU within the ED of its flagship adult hospital.”

Patient outcomes related to the opening of a new model of intensive care unit that is adjacent to the emergency department of a university hospital (with about 75,000 adult ED visits annually) are described in this scholarly article.  The Joyce and Don Massey Family Foundation Emergency Critical Care Center, known as EC3, at Michigan Medicine (Ann Arbor) is a 7,800-sf unit with nine patient rooms and five resuscitation/trauma bays.  Patients stay in the EC3 for about 9 hours on average.  This new model of care was found to reduce mortality and decrease the rate of admission of ED patients to inpatient intensive care units.

Source: Gunnerson, K.J., and others. (2019, July 24). Association of an emergency department-based intensive care unit with survival and inpatient intensive care unit admissions. JAMA Network Open, 2(7).  Click here for full text:  https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2738625  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

PHYSICIANS: Cardiovascular surgeons and invasive cardiologists generate the most revenue

The amount of revenue generated by different specialties for the hospitals where they practice is analyzed every three years by Merritt Hawkins, a physician recruiting firm.  New data for 2019 edition show the following specialties to be the highest in revenue generation (these figures are rounded):

  • $3.7 million: Cardiovascular Surgery
  • $3.5 million: Invasive Cardiology
  • $3.4 million: Neurosurgery
  • $3.3 million: Orthopedic surgery
  • $3 million: Gastroenterology

Primary care physicians, as a group, generated about $2.1 million each for their hospitals.  There is also a cost/benefit analysis in this report, which compares the average revenue generated with the average salary for each specialty.

Source: Merritt Hawkins. (2019). 2019 physician inpatient/outpatient revenue survey.  Click here: https://www.merritthawkins.com/uploadedFiles/MerrittHawkins_RevenueSurvey_2019.pdf  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

STROKE: Patients who receive physical therapy (PT) services are less likely to be readmitted

Our findings clearly demonstrate that higher intensity of rehabilitation services in the acute setting has a major impact on downstream outcomes, such as hospital readmission.”

Older patients who have suffered an ischemic stroke are less likely to be readmitted to the hospital within 30 days if they participate in physical therapy while in the hospital for the stroke.  This was a study of nearly 89,000 Medicare fee-for-service patients who were hospitalized nationwide in 2010.  Overall, the 30-day readmission rate was found to be 14 percent.

Source: Kuman, A., Resnik, L., Karmarkar, A., and others. (2019, July). Archives of Physical and Medical Rehabilitation, 100(7), 1218-1225. Click here for free full text:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6599551/pdf/nihms-1013343.pdf   Posted by AHA Resource Center (312) 422-2003, rc@aha.org

PEDIATRICS: Kangaroo mother care for preterm infants in neonatal intensive care units

To improve the NICU experience for mothers and promote the health of preterm infants, social supports, such as improved maternity leave policies and reliable hospital access through child care, accommodation, and transportation supports are required, even for parents with insurance coverage.”

This is a small study based on interviews with 20 mothers who gave birth to preterm infants in 2016 at Tufts Medical Center (Boston).  The objective was to evaluate how these mothers of infants in the neonatal intensive care unit viewed the practice of kangaroo mother care – which involves skin-to-skin contact and frequent breast feeding.  Barriers to use of this practice are explored.

Source: Lewis, T.P., Andrews, K.G., Shenberger, E., and others. (2019). Caregiving can be costly: A qualitative study of barriers and facilitators to conducting kangaroo mother care in a US tertiary hospital neonatal intensive care unit. BMC Pregnancy and Childbirth, 19:227. Click here for free full text:     https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-019-2363-y#Abs1  Posted by AHA Resource Center (312) 422-2050 rc@aha.org

TURNAROUNDS: How to effect change quickly at a struggling hospital using ‘buddying’ mentoring approach

How a buddying partnership was used to implement a quality improvement initiative at Medway NHS Foundation Trust, a large general hospital located near London, England, is described in this detailed case study.  Medway’s partner in the buddying agreement was Guys and St. Thomas’ Hospitals Hospital NHS Foundation, which provided “advice, operational assistance, ‘compassionate’ leadership and pastoral staff…”  This team approach was successful in quickly improving patient throughput issues.

Source: Leach, R., Banerjee, S., Beer, G., and others. (2019). Supporting a hospital in difficulty: Experience of a ‘buddying’ agreement to implement a new medical pathway. Future Healthcare Journal, 6(1), 67-75. Click here for full text:  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6520082/pdf/futurehealth-6-1-67.pdf  Posted by AHA Resource Center (312) 422-2050,  rc@aha.org

MODELS OF CARE: Geographic unit-based teams case study

Redesign of the care model for inpatient units at Brooklyn Hospital Center (NY, 464 beds)  is described in this article.  Previously, hospital medicine teams would round on patients scattered about the hospital.  After the redesign, geographic unit-based teams were created.  How staff handled the transition to the new model and interactions with the bed board system are discussed.  Workstations on wheels (WOWs) were added to rounds.  Provider and patient satisfaction were found to improve after implementation of the new model.

Source: Pendharkar, S., Malieckal, G., and Gasperino, J. (2019, May 10). Unit-based models of care. The Hospitalist.  Click here for full text:  https://www.the-hospitalist.org/hospitalist/article/200713/mixed-topics/unit-based-models-care  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

Rural Obstetric Services: Access, Workforce, and Impact

A new research briefing looks at declining access for rural women to obstetric services. Between 2004 and 2014, 179 rural counties in the U.S. lost hospital-based obstetric services, with over half of rural counties now lacking these services. The distribution of rural counties without obstetrics services varies widely geographically, from 78% in Florida to 9% in Vermont.

Access to obstetric service factors may be related to lower birthrates, a limited rural obstetric workforce, Medicaid eligibility, and socio-economic factors. The impact of limited OB services is also briefly covered.

Links to the nine reports covered by the research overview — all from the University of Minnesota Rural Health Research Center — are  provided.

Source: Rural obstetric services: access, workforce, and impact. Rural Health Research Recap, Rural Health Research Gateway, April 2019. https://www.ruralhealthresearch.org/recaps/8

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