Interns Account for Much of the Variation in Length of Stay on a General Medicine 5.20.08
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A study of 996 patients over 1,125 hospitalizations on a general medicine service found that interns accounted for much of the variation in patient length of stay, even after controlling for patient characteristics. The study found that intern-level factors alone explained 49.3% of the observed variation in length of stay, while resident-level factors explained 9.5% and attending-level factors only 2.4%. Reducing the variation between interns, such as moving the interns with the longest patient stays to the median, could lower overall length of stay by up to 10%.
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![Interns account for much of the variation in length of stay on a general medicine service C. Jessica Dine MD, Lisa M. Bellini MD, Theodore J. Iwashyna MD PhD Division of Pulmonary and Critical Care, Department of Medicine (CJD, LMB, TJI), Leonard Davis Institute of Health Economics (TJI), University of Pennsylvania School of Medicine, Philadelphia, PA ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Objectives ,[object Object],[object Object],[object Object],[object Object],Methods ,[object Object],[object Object],Conclusions ,[object Object],[object Object],[object Object],Limitations ,[object Object],[object Object],[object Object],[object Object],Results ,[object Object],[object Object],Background ,[object Object],[object Object],Policy Implications Table: Potential Reductions in Overall Length of Stay from Reducing Variation Between Interns Duration of Hospitalization Average LOS Moving Bottom ¾ to 25 th Percentile Moving Bottom ½ to 50 th Percentile ≤ 28 days 6 days 23% (1.4 days) 10% (0.6 days) ≤ 14 days 5 days 25% (1.2 days) 9% (0.4 days)](https://image.slidesharecdn.com/iwashynajack-internsaccountformuchofthevariationinlengthofstayonageneralmedicine-5-20-08-100818145939-phpapp01/85/Interns-Account-for-Much-of-the-Variation-in-Length-of-Stay-on-a-General-Medicine-5-20-08-1-320.jpg)
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This study examined the impact of resident duty hour reform on hospital readmission rates using an observational study with interrupted time series analysis of Medicare patients admitted to hospitals from 2003 to 2010. The study found no evidence that readmission rates improved or worsened after duty hour reform when comparing hospitals of different teaching intensities. Readmission rates neither improved nor worsened in association with duty hour reform, and these findings were robust across composite measures of readmission and mortality. The results provide evidence that duty hour reform did not generally impact patient outcomes.Interns Explain the Predominance of Variation in Laboratory Utilization on Tw...
Interns Explain the Predominance of Variation in Laboratory Utilization on Tw...Leonard Davis Institute of Health Economics
Interns explain the predominance of variation in laboratory utilization on two subspecialty services. As the supervision increases to the more acute setting of the Medical Intensive Care Unit, more of the explanation is shared among the providers on the team. The study found that interns had the predominant impact on variations in laboratory utilization on the general medicine service, while in more acute settings like the MICU, attending physicians and residents also contributed to variations. Limitations include this being a single-center study that did not link variations in laboratory utilization to patient outcomes.The Clinical Application of Tele-health in the care of people with ALS
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DH_Publications
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Does the Organizational Quality of the Psychiatric Nurse Practice 10.13.08
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This study examined the relationship between organizational factors of the nurse practice environment and untoward clinical outcomes reported by psychiatric nurses in Pennsylvania hospitals. The study found that hospitals rated as having an "unfavorable" nurse practice environment had more frequent reports of medication errors, infections, injuries, and verbal abuse compared to hospitals with "mixed" or "favorable" environments. Specifically, higher ratings of overall nurse practice environment quality, skilled unit managers, and nurse-physician relationships were associated with fewer reported incidents of infections, falls, and injuries.Compassion Fatigue RCT.pdf3584 wileyonlinelibrary.com
Compassion Fatigue RCT.pdf
3584 | wileyonlinelibrary.com/journal/jan J Adv Nurs. 2020;76:3584–3596.© 2020 John Wiley & Sons Ltd
Received: 2 May 2020 | Revised: 22 July 2020 | Accepted: 24 July 2020
DOI: 10.1111/jan.14568
O R I G I N A L R E S E A R C H : C L I N I C A L T R I A L
Effect of a compassion fatigue resiliency program on nurses’
professional quality of life, perceived stress, resilience:
A randomized controlled trial
Tuğba Pehlivan1 | Perihan Güner2
1Koç University Hospital, Istanbul, Turkey
2Istanbul Bilgi University Faculty of Health
Sciences, Istanbul, Turkey
Correspondence
Tuğba Pehlivan, Koç University Hospital,
Istanbul, Turkey.
Email: [email protected]
Funding information
This research received no specific grant
from any funding agency in the public,
commercial, or not-for-profit sectors.
Abstract
Aims: This study aimed to conduct a short- and long-term Compassion Fatigue
Resiliency Program and compare its impact on nurses’ professional quality of life,
perceived stress, and resilience.
Design: The research was conducted between January 2017 January 2019 as a ran-
domized controlled trial.
Methods: The sample comprised 125 oncology–haematology nurses randomly as-
signed to a Experimental I, Experimental II, or control group. The Compassion Fatigue
Resiliency Program was conducted with the nurses as an intervention. Experimental
I received a short-term program (5 hr per day for 2 days, 10 hr in total) while
Experimental II received a long-term one (5 weeks, 2 hr per week, 10 hr in total).
Measurements were obtained during pre- and post-test and at 3-, 6-, and 12-month
follow-ups. Research hypotheses were analysed using multilevel models.
Results: The results of multilevel model analyses showed there was no statistically
significant difference between mean scores for compassion fatigue, burnout, per-
ceived stress, and resilience of nurses in the short- or long-term groups or of those
in the control group. Mean compassion satisfaction scores of nurses in the short- or
long-term groups were significantly higher than those in the control group. Mean
compassion satisfaction scores of nurses in the short- or long-term groups were sig-
nificantly higher than the control group's pre-test mean after 6 and 12 months.
Conclusion: This study concluded that short- or long-term programs had no influ-
ence on compassion fatigue, burnout, perceived stress, and resilience; however, both
programs positively affected compassion satisfaction. We recommend that further
studies be conducted, which will help determine the effectiveness of new programs.
Impact: Caring for patients with cancer can generate work-related stress that can
negatively affect oncology nurses’ physical and emotional health, which could lead
to compassion fatigue. The program provided nurses with an opportunity to improve
their compassion satisfaction. Because there was no difference between both pro-
grams regarding mean compa ...
Impact of ERAS Protocol on the Post-Operative Complications in Colorectal Sur...
The patient experiences post-operative complications after colorectal surgery. To reduce these complications,
the ERAS protocol was developed. The current study assesses the
impact of ERAS on the post-operative complications after colorectal surgery.
Impact of ERAS Protocol on the Post-Operative Complications in Colorectal Sur...
The patient experiences post-operative complications after colorectal surgery. To reduce these complications,
the ERAS protocol was developed. The current study assesses the
impact of ERAS on the post-operative complications after colorectal surgery
Effect of nursing intervention on clinical outcomes and patient satisfaction ...
1) The study aimed to determine the effect of nursing intervention on clinical outcomes and patient satisfaction among patients with upper gastrointestinal bleeding.
2) A quasi-experimental study was conducted on 50 patients divided into a study group that received nursing intervention and a control group.
3) Statistically significant differences were found between the groups in clinical outcomes like bleeding, vital signs, and lab tests as well as higher patient satisfaction scores in the study group compared to the control group, showing that nursing intervention improved patients' outcomes and satisfaction.
Nejm journal watch practice changing articles 2014
This document provides a compilation of summaries of the latest practice-changing articles from NEJM Journal Watch. It includes summaries of articles on topics such as delayed or no antibiotic prescriptions for respiratory infections, physical therapy being beneficial for knee osteoarthritis, low-dose steroids being better than high-dose for COPD exacerbations, a diagnostic algorithm for upper-extremity deep vein thrombosis, evidence that meniscal tears may not require surgery, improvements in mental health with smoking cessation, doubts cast on flu drugs by meta-analyses, the 2014 recommended childhood immunization schedule, sentinel lymph node biopsies for thin melanomas, age-specific d-dimer cutoffs for pulmonary embolism, evidence that FOD
CAUTI Article
Physician-initiated daily verbal reminders to remove unnecessary urinary catheters decreased catheter duration more than nurse-initiated reminders. In a study comparing the two approaches, the mean catheter duration after physician reminders was 0.5 days compared to 1.7 days for nurse reminders. The physician reminders also significantly decreased catheter duration compared to a control group that received no reminders. Daily reminders from an infectious disease physician who was familiar with the hospital teams may have led to quicker catheter removal than from infection control nurses.
Luisetto m, ghulam r m. intensive care units the clinical pharmacist role to ...
Luisetto m, ghulam r m. intensive care units the clinical pharmacist role to ...M. Luisetto Pharm.D.Spec. Pharmacology
Clinical pharmacists play a crucial role in intensive care units (ICUs) by reducing mortality rates and improving clinical outcomes. A review of relevant literature found that pharmacist involvement on medical rounds, antimicrobial stewardship programs led by pharmacists, and higher levels of clinical pharmacist staffing were associated with lower mortality, shorter hospital stays, fewer adverse drug events, and lower costs. Ensuring pharmacists are integrated members of the multidisciplinary ICU team can help optimize medication management and safety for critically ill patients.roleofhospitalpharmacistsintransitionsofcare-130301172100-phpapp01 (1).pdf
Transitions of care refer to the movement of patients between different healthcare settings or providers. Medication errors are common during transitions of care and can negatively impact patient outcomes. Three studies found high rates of medication errors or discrepancies during hospital admissions and discharges. Rates of unintended medication discrepancies ranged from 53.6-60% and a significant portion were considered clinically important. Hospital pharmacists can play an important role in reducing medication errors during transitions. Activities like medication reconciliation at admission and discharge can identify up to 486 discrepancies per 100 patients discharged. Pharmacist involvement is associated with reduced rates of medication errors and improved patient outcomes.
Healthcare transition.pptx
Transitions of care between healthcare settings like hospitals, primary care, and home present opportunities for errors and safety issues. Medication discrepancies occur for 30-80% of patients during transitions. Improving care coordination through standardized documentation, medication reconciliation, and follow up can help reduce errors and adverse events during these vulnerable periods. Primary care has an important role to play in transition management through activities like timely receipt of discharge information and follow up appointments.
Summer final defense presentation_FINAL_3-30-16
This document summarizes a DNP project that evaluated the implementation of a sedation vacation protocol in a medical intensive care unit (MICU). The purpose was to determine if the protocol reduced pneumonia incidence, intubation duration, and ICU length of stay. A literature review found support for daily sedation vacations, spontaneous breathing trials, and ventilator bundle care. Chart reviews of 33 patients in 2014 found the protocol was ordered for all patients but only documented for 67% of patients. Results were inconclusive on outcomes. Barriers to full protocol compliance were identified.
Journal readingg
This study compared non-operative management (antibiotics only) to surgical management (appendectomy) for uncomplicated acute appendicitis in children. 102 children were enrolled and allowed to choose their treatment. At 1 year, the success rate of avoiding appendectomy with non-operative management was 75.7%, and children who received non-operative management had fewer disability days and lower healthcare costs compared to those who received surgery. Non-operative management is an effective treatment option for children with uncomplicated appendicitis that results in less morbidity and costs than surgery.
AMERICAN JOURNAL OF CRITICAL CARE, January 2005, Volume 14, N.docx
AMERICAN JOURNAL OF CRITICAL CARE, January 2005, Volume 14, No. 1 71
• BACKGROUND Improving communication and collaboration among doctors and nurses can improve
satisfaction among participants and improve patients’ satisfaction and quality of care.
• OBJECTIVE To determine the impact of a multidisciplinary intervention on communication and collab-
oration among doctors and nurses on an acute inpatient medical unit.
• METHODS During a 2-year period, an intervention unit was created that differed from the control unit
by the addition of a nurse practitioner to each inpatient medical team, the appointment of a hospitalist
medical director, and the institution of daily multidisciplinary rounds. Surveys about communication and
collaboration were administered to personnel in both units. Physicians were surveyed at the completion
of each rotation on the unit; nurses, biannually.
• RESULTS Response rates for house staff (n = 111), attending physicians (n = 45), and nurses (n = 123)
were 58%, 69%, and 91%, respectively. Physicians in the intervention group reported greater collaboration
with nurses than did physicians in the control group (P < .001); the largest effect was among the residents.
Physicians in the intervention group reported better collaboration with the nurse practitioners than with
the staff nurses (P < .001). Physicians in the intervention group also reported better communication with
fellow physicians than did physicians in the control group (P = .006). Nurses in both groups reported simi-
lar levels of communication (P = .59) and collaboration (P = .47) with physicians. Nurses in the interven-
tion group reported better communication with nurse practitioners than with physicians (P < .001).
• CONCLUSIONS The multidisciplinary intervention resulted in better communication and collaboration
among the participants. (American Journal of Critical Care. 2005;14:71-77)
EFFECT OF A MULTIDISCIPLINARY INTERVENTION ON
COMMUNICATION AND COLLABORATION AMONG
PHYSICIANS AND NURSES
To purchase reprints, contact The InnoVision Group, 101 Columbia, Aliso
Viejo, CA 92656. Phone, (800) 809-2273 or (949) 362-2050 (ext 532); fax,
(949) 362-2049; e-mail, [email protected]
By Sondra Vazirani, MD, MPH, Ron D. Hays, PhD, Martin F. Shapiro, MD, PhD, and Marie Cowan, RN, PhD.
From the Schools of Medicine (SV, RDH, MFS) and Nursing (MC), University of California, Los Angeles,
and the Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System (SV), Los
Angeles, Calif.
C ollaboration has been defined as an interac-tion between doctor and nurse that “enable[s]the knowledge and skills of both profession-
als to synergistically influence the patient care being
provided.”1 The results of the demonstration project
of the National Joint Practice Commission with subjec-
tive interview data in the late 1970s suggested that
interventions that foster nurse-physician collaboration
improve the satisfaction of doctors, nurses, and patients.2
.
Iv To Po Pp[1]
Ryan Mills, a pharmacist candidate, evaluated implementing a program at Charleston Area Medical Center to switch patients earlier from intravenous to oral antibiotics based on certain criteria. In a study of 25 patients with community-acquired pneumonia, 13 met criteria for early switch, which could have resulted in over $400 in direct cost savings annually. The goals of the program were to maintain or improve outcomes while decreasing costs of IV drugs and patient care. A follow-up evaluation of 30% of patients switched found 100% cure rates with average cost savings of $44 per patient and decreased length of IV therapy.
Jpps luisetto m, mashori gr (2017) intensive care units the clinical pharmac...
Jpps luisetto m, mashori gr (2017) intensive care units the clinical pharmac...M. Luisetto Pharm.D.Spec. Pharmacology
The document discusses the role of clinical pharmacists in improving outcomes in intensive care units (ICUs). It reviews literature showing that clinical pharmacist involvement is associated with reduced mortality rates, shorter hospital stays, fewer medication errors and adverse drug events, lower infection rates, and decreased costs. Specifically, studies found that mortality rates were reduced by 23-43% and lengths of stay decreased by 1.3-2.4 days with clinical pharmacist services involved in ICU care. Pharmacists helped optimize medication management and drug protocols, which improved safety and outcomes for critically ill patients.Evaluating the impact of a specialist frailty multidisciplinary team pathway ...
Evaluating the impact of a specialist frailty multidisciplinary team pathway ...Health Innovation Wessex
The Health Innovation Network Polypharmacy Programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications.
Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely.
To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Evaluating the impact of a specialist frailty multidisciplinary team pathway with clinical pharmacist involvement, can be viewed here.
For more information about the polypharmacy programme, please visit https://thehealthinnovationnetwork.co.uk/programmes/medicines/polypharmacy/Similar to Interns Account for Much of the Variation in Length of Stay on a General Medicine 5.20.08 (20)
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Nejm journal watch practice changing articles 2014
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Luisetto m, ghulam r m. intensive care units the clinical pharmacist role to ...
Luisetto m, ghulam r m. intensive care units the clinical pharmacist role to ...
roleofhospitalpharmacistsintransitionsofcare-130301172100-phpapp01 (1).pdf
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AMERICAN JOURNAL OF CRITICAL CARE, January 2005, Volume 14, N.docx
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Jpps luisetto m, mashori gr (2017) intensive care units the clinical pharmac...
Jpps luisetto m, mashori gr (2017) intensive care units the clinical pharmac...
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LDI Research Seminar 9_7_12 Eff ects of Federal Policy to Insure Young Adults...Leonard Davis Institute of Health Economics
The document summarizes a study that analyzes the effects of the 2010 Affordable Care Act's dependent coverage mandate on young adults' health insurance coverage and labor market behavior using data from the 2008 panel of the Survey of Income and Program Participation. The study finds that the policy led to a 3.3 percentage point reduction in uninsurance among young adults ages 19-25, a 6.2 percentage point increase in dependent coverage through a parent's employer-sponsored insurance, and evidence of increased labor market flexibility for young adults.LDI Poster Template
This document provides a template for creating scientific posters. It includes suggestions for formatting, design principles, and sections like the title, abstract, methods, results, and conclusions. The template is meant to simplify poster creation and emphasize key points for viewers through techniques like italics, boldface, and effective use of space. Proper formatting of images, tables, and graphs is also discussed. The goal is to design posters that are easy to understand and focused on the needs of the audience.
LDI Charles Leighton Memorial Lecture with Mark Chassin, MD 5_4_12
LDI Charles Leighton Memorial Lecture with Mark Chassin, MD 5_4_12Leonard Davis Institute of Health Economics
1) Current state of quality and safety in healthcare is poor, with routine safety processes failing regularly and preventable adverse events occurring commonly.
2) High reliability organizations like commercial aviation have achieved much higher levels of safety through effective process improvement, a strong safety culture, and principles of collective mindfulness.
3) The Joint Commission aims to transform healthcare into a high reliability industry through initiatives like robust quality measurement, establishing accountability criteria for measures, and promoting high reliability principles.More from Leonard Davis Institute of Health Economics (20)
The Effects of Federal Parity on Substance Use Disorder Treatment_Andrew Epst...
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Does a Wireless Incentive Structure Improve Retention, Subject Satisfaction a...
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The Intersection of Attitudes and Organizational Factors by Provider Type in ...
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High Value Cost Conscious Care: Is it Rationing or Rational Care? 1_11_13
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LDI Research Seminar with Art Kellermann, MD, MPH 11_28_12
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CMHPSR/LDI Research Seminar_New Models for Childrens Mental Health Services D...
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LDI Research Seminar 9_7_12 Eff ects of Federal Policy to Insure Young Adults...
LDI Research Seminar 9_7_12 Eff ects of Federal Policy to Insure Young Adults...
LDI Charles Leighton Memorial Lecture with Mark Chassin, MD 5_4_12
LDI Charles Leighton Memorial Lecture with Mark Chassin, MD 5_4_12
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This document outlines policies and procedures for handling narcotic and controlled drugs in NABH accredited hospitals.
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Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
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This quiz was conducted as a promotional event for the 2024 Annual Meet of Kerala Chapter of API.
More than 20 participants took part everyday !
Travel Clinic Cardiff: Health Advice for International Travelers
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
DECLARATION OF HELSINKI - History and principles
This SlideShare presentation provides a comprehensive overview of the Declaration of Helsinki, a foundational document outlining ethical guidelines for conducting medical research involving human subjects.
Osteoporosis - Definition , Evaluation and Management .pdf
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Pharmacology of 5-hydroxytryptamine and Antagonist
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
The Nervous and Chemical Regulation of Respiration
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Hemodialysis: Chapter 5, Dialyzers Overview - Dr.Gawad
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Cell Therapy Expansion and Challenges in Autoimmune Disease
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
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