INQRI

Healthcare Risk Management Article July 20, 2010

Like Day and Night – Shedding Light on Off-Hours Care
David Shulkin n engl j med 358;20 www.nejm.org may 15, 2008

The consequences of service deficiencies during off-hours include higher mortality and readmission rates,3 more surgical complications,4 and more medical errors.5 Given the health care industry’s renewed focus on ensuring patient safety and providing high-quality medical care, why hasn’t the situation changed at the “other hospital”?

Read the FULL ARTICLE HERE.

Take a look at David Shulkin’s SWAN TOOL HERE.

Napping During Hospital Shifts
December 9, 2008 Editorial, The New York Times

No patient wants to be cared for by a sleep-deprived resident who has put in a brutal 30-hour shift within an 80-hour workweek. There is just too much chance that the sleep-deprived doctor’s foggy mind or clumsy coordination would cause dangerous medical errors.

Of course, it was a lot worse a decade or two ago when residents — the young doctors-in-training who provide most of the medical care in teaching hospitals — routinely worked 110 hours a week, sometimes for 36 hours at a stretch. That degree of exploitation was curtailed by a 1989 law in New York State and by standards issued in 2003 by the accrediting organization for residency programs. Both called for 80-hour workweeks.

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Caffeine Helps Shift Workers Avoid Mistakes
Jolt of java better than a nap to prevent mistakes, review finds

WEDNESDAY, May 12 (HealthDay News) — Good news for javaholics: A new review suggests that caffeine consumption can help night-shift workers avoid making mistakes.

At least 15 percent of workers in industrialized countries are thought to be engaged in shift work or permanent nighttime work, which can disrupt their body clocks. Some suffer from shift-work disorder, in which they only sleep for short periods of time and become sleepy on the job, boosting the risk of errors, the researchers explained.

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Article provided by Dempsey & Kingsland, P.C.

A number of recent studies show that patients admitted to hospitals on nights and weekends are less likely to receive immediate urgent medical care than those admitted on weekdays. You are statistically more likely to die if you check into a hospital on a weekend rather than on a weekday. While these studies’ conclusions do not generally prove causation, there are a number of factors that may contribute to the lower survival rates on nights and weekends. These include fewer staff on duty, less experienced physicians on duty at these times, tired doctors and nurses, less frequent monitoring of patients, limited access to certain procedures at night and on weekends and slower responses to patient distress.

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Of the 8 million patients who were admitted to U.S. hospitals on weekends in 2007, approximately one-third received needed major procedures on the day of admission, according to the latest data from the Agency for Healthcare Research and Quality. Yet 65 percent of patients who were admitted on weekdays received needed major procedures on their first day in the hospital.

Patients who were admitted on weekends were nearly three times more likely to be there due to emergencies, such as heart attack, stomach bleeding, fractures, or internal injuries than patients hospitalized on a weekday (28 vs. 11 percent). In addition, 65 percent of patients admitted on weekends were initially seen in hospital emergency departments compared with 44 percent of weekday-admitted patients.

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What is safe nurse staffing?

Safe staffing means that enough health care providers with the necessary range of skills are always available to meet patients’ needs and to eliminate preventable errors, to the greatest extent possible.

Safe staffing plans should take into account:

• Patient acuity (severity of illness)

• Time for RNs to assess patients and make decisions on care

• Frequently changing patient needs

Safe Nursing Staffing Poll Results

ANA asked nurses to participate in its online Safe Staffing Poll. The results below are based on 16,295 responses received between March 31, 2008 and April 13, 2010. These results clearly highlight the need for adequate nurse staffing and its importance in the delivery of quality patient care.

Poll Results

Reversing the Trend: Researchers Investigate How Nurses Can Improve Patient Care During “Off-Peak” Hours

By Robert Wood Johnson Foundation
May 3, 2010 – 6:59:14 AM

(HealthNewsDigest.com) – More than 30 years ago, researchers noticed that patients admitted to hospitals during “off-peak” hours, like evenings and weekends, experienced more health problems. Their study showed that patients admitted at night or on weekends were less likely to survive in-hospital cardiac arrest and that newborns born on weekends were more likely to die than babies born during the week.

Numerous studies have verified this phenomenon, but none have ascertained the causes or suggested ways to reverse the trend, until now. An interdisciplinary team of health researchers, including two nurses, has identified the causes of some of these disparities and made preliminary recommendations for changes in nursing administration that could help.
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A Comparison of In-hospital Mortality Risk Conferred by High Hospital Occupancy, Differences in Nurse Staffing Levels, Weekend Admission, and Seasonal Influenza
Offical Journal of the Medical Care Section, American Public Health Association

Schilling, Peter L. MD, MSc; Campbell, Darrell A. Jr MD, FACS; Englesbe, Michael J. MD; Davis, Matthew M. MD, MAPP

Abstract

Background: Hospital occupancy, nurse staffing levels, weekend admission, and seasonal influenza have all been shown to be associated with in-hospital mortality. Yet, no study has simultaneously compared the strength of associations of these 4 factors with in-hospital mortality.

Objective: To compare the risk of in-hospital mortality conferred by high hospital occupancy on admission, increased nurse staffing levels, weekend admission, and seasonal influenza.
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A STEMI code protocol improves door-to-balloon time on weekdays and weekends.

Abi Rafeh N, Abi-Fadel D, Wetz RV, Khoueiry G, Azab B, Edwards A, Ardolic B, El-Sayegh S, Baldari D, Malpeso JV, Costantino T.
J Healthc Qual. 2009 Nov-Dec;31(6):35-43.

Department of Medicine, Staten Island University Hospital, Staten Island, NY, USA.

Abstract

Primary percutaneous coronary intervention (PCI) has emerged as the standard of care for the management of ST-elevation myocardial infarctions (STEMI). Only 32% of patients with STEMI receive this procedure within the recommended 90 min for door-to-balloon time (DTB). We reviewed all STEMI cases that presented to our institution before and after the implementation of a STEMI Code protocol. Before the STEMI Code protocol, 27.1% of weekday cases and 6.3% of weekend cases were performed within 90 min. After the STEMI Code protocol, there was a threefold increase in the number of patients who received PCI within 90 min (p<.0001). A STEMI Code protocol dramatically improves DTB and equalizes disparities between weekday and weekend care.
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