Two executives of the former Province Healthcare Co. have launched a Brentwood, TN-based operation to acquire and operate hospitals in rural areas at a time when healthcare analysts say such deals may abound as companies try to cope with tighter capital markets. WithRegionalCare Hospital Partners, executives Marty Rash and John M. Rutledge are banking that they will be able to buy community hospitals that need fresh partners and more capital to expand.
Two top administrators at Nashville-based Vanderbilt University Medical Center will be leaving at the end of July as part of recent leadership changes. Joel Lee, associate vice chancellor for communications at the medical center, and Rick Wagers, senior vice president for medical center finance, won't be a part of the medical school's new executive leadership team, according to an announcement posted Vanderbilt's Web site.
Increases in healthcare costs for consumers aren't likely to slow next year with HMO rates projected to jump nearly 12% in 2010, a new study by benefits consulting firm Hewitt Associates indicates. Though the Hewitt study looked only at HMOs, it provides a snapshot at where companies are in negotiating rates for next year with insurers, according to the Chicago Tribune.
In this lengthy piece for the New York Times, Princeton University bioethics professor Peter Singer says that while "rationing" has become a dirty word in health reform talks, doing so means getting value for the billions the U.S. is spending on healthcare by setting limits on which treatments should be paid for by the public. "If we ration we won't be writing blank checks to pharmaceutical companies for their patented drugs, nor paying for whatever procedures doctors choose to recommend. When public funds subsidize healthcare or provide it directly, it is crazy not to try to get value for money," Singer says.
A significant portion of surgical residents think the hours imposed on their work schedules inhibit their surgical education and puts patients' safety at risk, according to a study published in the July Journal of the American College of Surgeons. Although not a majority, 41% of surgical residents included in the study felt that the duty hour regulations implemented by the Accreditation Council for Graduate Medical Education (ACGME) presented a "moderate barrier" to their surgical education.
The duty hour regulations were originally put in place by the ACGME in 2003 in an effort to prevent surgical errors, keep patients safer, and give residents more time on their own by acknowledging that overtired residents are more prone to make mistakes. Currently surgical residents are required to work no more than 80 hours in a week, and have no less than 10 hours between shifts. The Institute of Medicine is recommending that residents working any overnight shifts of 30 hours or longer be given time to nap and that residents work no longer than a 16 hour shift without sleep.
Because of the ACGME hour restrictions, surgical residents do report getting more sleep and having more time for their personal lives. However, a significant of surgical residents percentage are reporting that they think patients' safety is being negatively affected by the hour restrictions due to increased patient handoffs and lack of continuity of care. Forty-three percent of respondents felt that the ideal work week would be between 80 and 100 hours, while 52% thought that the 60-80 hours was adequate.
"We were surprised to find that nearly half of surgical residents believe work-hour restrictions are actually an impediment to their training," said Jacob Moalem, MD, Department of Surgery, University of Rochester (NY) Medical Center, and lead author of the study. "Our current system limits educational opportunities for surgeons who are expressing a desire and a need to learn more in a compact timeframe. Senior surgery residents should be given the chance to control their own schedules as they continue to refine their technical skills and transition into independent practice."
The study surveyed resident and associate members of the American College of Surgeons electronically, of which 599 responded. They were asked to rate if the duty hour regulations affected their surgical education, and also what the appropriate number of hours per week they think should be worked during their postgraduate year from the choices of less than 60, 60 to 80, 80 to 100, or more than 100.
Interestingly, residents who were closer to graduation were those who more strongly felt that the duty hour regulations interfered with their education as compared with residents in their first and second years. Seven percent of junior residents reported that the duty hour regulations did not impede on their education, while 32% of residents in or post their seventh postgraduate year said they felt the regulations interfered with their education.
The researchers concluded that having a "one size fits all" rule for hours may not be the best practice. Instead, finding a schedule that works for individual residents may result in safer patients and better educated surgeons.
Although the hour limitations were put in place to promote patient safety, there has been little evidence published to show that the reduction in hours actually does improve patient safety. Some hospitals are finding it difficult to balance the hour limitations while providing safe care for patients and adequately educating surgeons. However, surgical programs do strive for compliance and have focused more on promoting well rested residents since 2003.
Nearly three-quarters of nurses who participated in an American Nurses Association (ANA) online poll that drew almost 15,000 responses reported insufficient staffing at their workplace. Forty-two percent of respondents also cited inadequate staffing as the reason they were considering leaving their position—suggesting nurse shortages will worsen.
The results of the anonymous poll that's been live on the Safe Staffing Saves Lives Campaign Web site since March 2008 were released last week, illustrating the need for sufficient nurse staffing and nurses' views on its significance to the delivery of quality patient care.
The majority (84%) of respondents indicated they were employed at hospitals and most (76%) worked full-time. Nearly 75% were staff nurses. Furthermore, nurse experience levels varied, with 55% reporting less than 15 years experience and 45% more than 15 years.
While the number of respondents who reported staff shortages is high, it isn't necessarily alarming, but concerning that it still is an issue.
"Staffing has been an ongoing issue for decades," says Isis Montalvo, MS, MBA, RN, director of the ANA's National Center for Nursing Quality. She adds that the ANA recognized concerns related to sufficient staffing in the early 1990s. "During that time, a lot of hospitals were reengineering and cutting back positions, and nurses knew that cutting back positions would affect patient outcomes. The ANA [has since] funded quite a bit of research and multiple studies to identify the linkages between staffing and patient outcomes." The work continues with ANA's National Database of Nursing Quality Indicators®.
What may be surprising is nurses' candor about the effects such staffing are having on patient care.
For example, more than half of the nurses (52%) who took the poll reported the quality of care on their unit declined in the past year, and half said they would not feel confident having someone close to them receive care in their facility.
"By [the respondents] identifying ‘No, I wouldn't come to this facility,' that says something because they're in that working environment," Montalvo says. "And while we want to all take pride in what we do, nurses are first and foremost patient advocates. So they are being very candid about their work environment and why they may not want family to come there."
Time—or nurses' lack of—appears to be one factor influencing care quality.
Sixty-six percent of nurses reported that they "always" perform non-nursing activities, such as delivering meals, transporting patients, and drawing labs, while still carrying out their usual nursing duties. A meager 2% reported "never" performing non-nursing tasks. In addition, nearly one-quarter said they were "rarely" able to take a full meal break.
Looking to the future, much needs to be done to keep nurses from flocking from the profession. "When it comes to retaining nurses and taking a look at the work environment, there are many aspects that are very important for nurses," Montalvo says. "Is there shared decision making? Are they being included in the decisions that make an impact in their work environment, as for their patients? Do they have autonomy in their respective roles?"
Montalvo also stresses the need for collegial relationships, strong nurse leadership, and nurse managers with the ability to support staff in their work and advocate on their behalf.
Growth in social network advertising spending worldwide will take a hit in 2009, eMarketer projects, but not as severely as in the US. eMarketer is predicting 9% growth in worldwide spending in 2009, to $2.2 billion. This estimate is down from the 17% growth the company forecast in March 2009.
Kaiser Permanente surveyed 4,560 Medicare beneficiaries about their online habits and health status and found that more than 87% of them that are registered to use Kaiser Permanente's My Health Manager personal health record are satisfied, or very satisfied, with the technology.
Counterfeit drugs cost drug companies a lot of money each year and also can cause long-term side effects or in some cases death. Drug company Pfizer and its agency, Universal McCann, decided to take the lead in fighting against the availability of counterfeit drugs on the internet and shock people with a multiplatform campaign that ran in the UK with the central image of a rat coming out of a person's mouth.
When the brand new West Chester (OH) Medical Center opened, locals streamed in to view the much-anticipated patient-centered building. They entered the glass-domed rotunda from the covered drop-off area, wandered along the arc of diagnostic and treatment areas, and strolled through bright lounges and open spaces. Planners designed the 385,000-square-foot medical center's so that it was visually engaging, patient- and technology-focused, and easy to navigate.
The hospital's owner, Health Alliance of Cincinnati, brought in some of its network's most innovative clinicians to work with designers and develop a new and efficient healthcare environment for the 162-bed, five-story facility.
"By working with the future doctors and staff of West Chester Medical Center, we found that their overarching vision was for the new hospital to focus on patients and families," said Michael Hoffmeyer, AIA, ACHA, project manager. "Our design strives to fulfill this vision in two ways. First, the design focuses on a holistic, integrated view of care rather than a model that moves patients between departments. Second, initial patient ‘touch points' are clustered around the central rotunda to ease wayfinding and make the hospital seem more intimate and friendly."
The public face of the building is a sheer glass wall and offers views both inside and outside that help visitors stay oriented.
"Off the rotunda, related medical services are clustered together, with diagnostic and treatment areas in a radial arc, imaging located next to the emergency department, and outpatient services easily accessible on the ground floor," according to a press release from RTLK, the building design firm. "The entire hospital emphasizes clear and concise visual organization of space that helps users easily find their destinations."
