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INTRODUCTION: Health disparities have been widely studied in the primary care and surgical settings. The purpose of this study was to examine surgical access disparities for orthopaedic surgical cases performed at a large academic health center by comparing the relationship between patient demographic factors and surgical wait time. METHODS: A total of 24,778 orthopaedic surgical cases from 2018 to 2022 at a public, tertiary care, Level I trauma center were retrospectively analyzed to assess for surgical timing disparities based on patient-specific factors, including race, sex, language, and socioeconomic status. RESULTS: Elective surgical cases were completed with an average surgical wait time of 28.11 ± 26.34 days. Urgent surgical cases were completed with an average surgical wait time of 1.23 ± 1.50 days. Patient race, sex, language, and socioeconomic status had no effect on surgical wait time for urgent case scheduling. Female patients had longer average wait times in elective cases, whereas race had a weak association with increased wait time. Two-factor interaction analysis showed no multifactorial effects of patient demographic factors on surgical wait time. Patient race and socioeconomic status were associated with increased distance from surgical sites, although increased distance did not correlate with increased surgical wait time. CONCLUSION: Patient demographic factors did not demonstrate clinically notable associations with surgical timing in this patient cohort, in contrast to previous studies demonstrating the effects of race and socioeconomic status on healthcare outcomes and access. Race and socioeconomic status did correlate with increased distance from surgical centers although distance from surgical sites did not correlate with surgical wait time. This contributes to previous literature on healthcare equity and indicates that surgical wait time may not contribute to the known healthcare inequalities seen in minority and marginalized patients.
Asunto(s)
Equidad en Salud , Disparidades en Atención de Salud , Procedimientos Ortopédicos , Humanos , Femenino , Masculino , Estudios Retrospectivos , Persona de Mediana Edad , Procedimientos Quirúrgicos Electivos/estadística & datos numéricos , Listas de Espera , Accesibilidad a los Servicios de Salud , Adulto , AncianoRESUMEN
Postoperative infections can complicate patient care and increase health care costs. A vascular preventative bundle was implemented at a large teaching/research intensive hospital to decrease surgical site infections (SSIs) with vascular surgery patients. The aim of this study was to measure fidelity to the bundle and determine if implementation of the vascular SSI bundle reduced the rate of SSIs. Three periods of data were collected, and they are identified as preimplementation (period 1), early implementation (period 2), and postimplementation (period 3). There were 711 patients for all three periods, approximately equally distributed in the periods. The use of preoperative hair clippings, chlorhexidine (CHG) wipes, and appropriate antibiotics showed the greatest improvement from preimplementation to early implementation. All three measures showed significant improvements in fidelity. For appropriate antibiotics, the fidelity was the highest and showed the largest improvement compared to the other measures. The performance of clippings preoperatively and using CHG wipes improved significantly. Evidence-based interventions have been recommended to support the implementation and sustainability of the bundle. The infection rate between preop and postperiod was not statistically different.
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Paquetes de Atención al Paciente/métodos , Infección de la Herida Quirúrgica/prevención & control , Procedimientos Quirúrgicos Vasculares/efectos adversos , Enfermería Cardiovascular , Clorhexidina/uso terapéutico , Femenino , Humanos , Masculino , Infección de la Herida Quirúrgica/etiologíaRESUMEN
Health care bullying is a pervasive, underestimated, and underreported problem that results in poor outcomes for staff, patients, and health care organizations. The most common form of health care bullying occurs between nurses. Nurse managers hold an important role in the prevention and elimination of frontline nurse-to-nurse bullying. An anonymous Web-based survey was conducted to uncover what behaviors nurse managers perceive as bullying and how they respond to bullying acts. Respondents who had witnessed or been victimized by bullying were more apt to identify bullying and those who had been victimized or supervised nurses for more than 20 years were more prone to act upon bullying behaviors. There was only a moderate correlation between the identification of and response to bullying behaviors. Finally, overt bullying elicited a stronger response for intervention than covert bullying. Although nurse managers are well positioned to prevent and eliminate nurse-to-nurse bullying, they may not recognize it and often lack the skills and support necessary to address it. Decreases in nurse-to-nurse bullying reduce health care costs, improve nurse and patient satisfaction, and enhance patient outcomes. Therefore, nurse managers at all levels need education and support to ensure proper identification of bullying and, furthermore, to prevent and eliminate the behaviors.
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Actitud del Personal de Salud , Acoso Escolar/prevención & control , Enfermeras Administradoras/normas , Enfermeras y Enfermeros/psicología , Adulto , Femenino , Humanos , Relaciones Interprofesionales , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Lugar de Trabajo/psicología , Lugar de Trabajo/normasRESUMEN
OBJECTIVES: To predict adoption (80% rate of use) of an electronic health record (EHR) by admitting physicians using a heuristic model. METHODS: Administrative data collected for 326 physicians who admitted at least 10 patients to 3 hospitals during the 6 months following EHR activation represented more than 80% of the total admissions. Functions evaluated included computerized physician order entry (CPOE), electronic history and physical (EH and P), and electronic discharge summary (EDS). Independent variables included hospital size, physician alignment, physician group size, use of an office EHR, age, sex, specialty, volume, hospital based, inpatient to outpatient ratio, and loyalty. RESULTS: CPOE adoption was more likely (P <.01) for physicians who were employed, male, and had a high inpatient ratio, a lower patient volume, and a community hospital setting. EH and P and EDS adoption were more likely for physicians with financial alignment and a large academic hospital setting. CONCLUSIONS: Personal factors (loyalty, age, sex) were generally not predictive. Organizational factors (hospital setting, financial alignment) were most predictive of adoption. Study results may help administrators improve EHR installations.