RESUMEN
On the 20th of March 2020, triggered by the public health emergency declared, the Health Authorities in Madrid reported a legal instruction (Orden 371/2020) indicating the organization of a provisional hospital to admit patients with COVID-19 at the Trade Fair Institution (IFEMA). Several pharmacists working in the Pharmacy and Medical Devices Department of the Madrid Regional Health Service were called to manage the Pharmacy Department of the abovementioned hospital. Required permissions to set up a PD were here authorized urgently. Tackling human and material resources, and computer systems for drug purchase and electronic prescription, were some of the initial issues that hindered the pharmaceutical provision required for patients from the very day one. Once the purchase was assured, mainly by direct purchase from suppliers, drug dispensing up to 1,250 hospitalized patients (25 nursing units) and 8 ICU patients was taken on. Dispensing was carried out through either drug stocks in the nursing units or individual patient dispensing for certain drugs. Moreover, safety issues related to prescription were considered, and as the electronic prescription was implemented we attained 100% prescriptions review and validation. The constitution of a multidisciplinary Pharmacy and Therapeutics Committee let agree to a pharmacotherapy guide, pres cription protocols, therapeutic equivalences, interactions, and drug dispensing circuits. The Pharmacy Department strategy was to ensure a very quick response to basic tasks keeping the aim to offer a pharmaceutical care of the highest quality whenever possible. Working under a health emergency situation, with many uncertainties and continuous pressure was a plight. However, the spirit of collaboration in and out of the Pharmacy Department was aligned with the whole hospital motivation to offer the highest quality of healthcare. These were possibly the keys to allow caring for almost 4,000 patients during the 42 days that the hospital lasted.
El día 20 de marzo de 2020 la Consejería de Sanidad publicó una Orden (371/2020) para la apertura de un centro hospitalario provisional para atender a pacientes COVID-19 en la Institución Ferial de Madrid (IFEMA), por razón de emergencia sanitaria. Se dispuso un equipo de farmacéuticos de la Subdirección General de Farmacia y Productos Sanitarios para la apertura de un Servicio de Farmacia, que obtuvo la autorización correspondiente por el órgano competente, con carácter de urgencia. La gestión de recursos humanos, materiales y de herramientas informáticas para la adquisición y prescripción electrónica fueron unas de las primeras dificultades que se solaparon con el primer reto de garantizar la prestación farmacéutica a los pacientes que atendía el hospital desde el mismo día uno. Asegurada la adquisición, fundamentalmente mediante la compra directa a proveedores, se planteó la dispensación para un máximo de 1.250 pacientes de hospitalización (25 controles de enfermería) y una Unidad de Cuidados Intensivos de 8 pacientes; se establecieron botiquines en las unidades de enfermería y circuitos individualizados de dispensación para determinados medicamentos. A su vez, desde el primer momento se trabajó en la seguridad en la prescripción, llegando a la revisión y validación del 100% de los tratamientos, una vez instaurada la prescripción electrónica. La creación de una Comisión de Farmacia y Terapéutica multidisciplinar permitió consensuar la guía farmacoterapéutica, protocolos de prescripción, equivalencias terapéuticas, interacciones y circuitos de dispensación de medicamentos. La estrategia del Servicio de Farmacia se basó en asegurar una respuesta rápida en las funciones básicas, sin perder la visión de incorporar una atención farmacéutica de la máxima calidad posible a medida que iba siendo factible. A pesar de un escenario adverso, de incertidumbre y presión continuas por la emergencia sanitaria, se ha mantenido un espíritu de colaboración y contribución dentro y fuera del Servicio de Farmacia, alineado con un objetivo común de trabajo en equipo para brindar una atención sanitaria rápida y de la mayor calidad posible. Posiblemente éstas han sido las claves del éxito que han permitido atender a casi 4.000 pacientes en los 42 días de vida del hospital.
Asunto(s)
Infecciones por Coronavirus , Atención a la Salud/organización & administración , Hospitales Urbanos/organización & administración , Modelos Teóricos , Pandemias , Servicio de Farmacia en Hospital/organización & administración , Neumonía Viral , Betacoronavirus , COVID-19 , Atención a la Salud/legislación & jurisprudencia , Atención a la Salud/métodos , Prescripción Electrónica/normas , Regulación y Control de Instalaciones/legislación & jurisprudencia , Predicción , Planificación de Instituciones de Salud , Necesidades y Demandas de Servicios de Salud , Hospitalización , Hospitales Urbanos/legislación & jurisprudencia , Humanos , Comunicación Interdisciplinaria , Seguridad del Paciente , Servicio de Farmacia en Hospital/legislación & jurisprudencia , Comité Farmacéutico y Terapéutico/organización & administración , Garantía de la Calidad de Atención de Salud , SARS-CoV-2 , EspañaRESUMEN
We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2017. Some of these changes will implement certain statutory provisions contained in the Pathway for Sustainable Growth Reform Act of 2013, the Improving Medicare Post-Acute Care Transformation Act of 2014, the Notice of Observation Treatment and Implications for Care Eligibility Act of 2015, and other legislation. We also are providing the estimated market basket update to apply to the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits for FY 2017. We are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) for FY 2017. In addition, we are making changes relating to direct graduate medical education (GME) and indirect medical education payments; establishing new requirements or revising existing requirements for quality reporting by specific Medicare providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities), including related provisions for eligible hospitals and critical access hospitals (CAHs) participating in the Electronic Health Record Incentive Program; updating policies relating to the Hospital Value-Based Purchasing Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition Reduction Program; implementing statutory provisions that require hospitals and CAHs to furnish notification to Medicare beneficiaries, including Medicare Advantage enrollees, when the beneficiaries receive outpatient observation services for more than 24 hours; announcing the implementation of the Frontier Community Health Integration Project Demonstration; and making technical corrections and changes to regulations relating to costs to related organizations and Medicare cost reports; we are providing notice of the closure of three teaching hospitals and the opportunity to apply for available GME resident slots under section 5506 of the Affordable Care Act. We are finalizing the provisions of interim final rules with comment period that relate to a temporary exception for certain wound care discharges from the application of the site neutral payment rate under the LTCH PPS for certain LTCHs; application of two judicial decisions relating to modifications of limitations on redesignation by the Medicare Geographic Classification Review Board; and legislative extensions of the Medicare-dependent, small rural hospital program and changes to the payment adjustment for low-volume hospitals.
Asunto(s)
Medicare/economía , Medicare/legislación & jurisprudencia , Sistema de Pago Prospectivo/economía , Sistema de Pago Prospectivo/legislación & jurisprudencia , Educación de Postgrado en Medicina/economía , Educación de Postgrado en Medicina/legislación & jurisprudencia , Hospitales de Bajo Volumen/economía , Hospitales de Bajo Volumen/legislación & jurisprudencia , Hospitales Rurales/economía , Hospitales Rurales/legislación & jurisprudencia , Hospitales Urbanos/economía , Hospitales Urbanos/legislación & jurisprudencia , Humanos , Cuidados a Largo Plazo/economía , Cuidados a Largo Plazo/legislación & jurisprudencia , Calidad de la Atención de Salud/economía , Calidad de la Atención de Salud/legislación & jurisprudencia , Estados Unidos , Heridas y Lesiones/economíaAsunto(s)
Hospitales Urbanos , Suicidio Asistido , Ética Médica , Accesibilidad a los Servicios de Salud/ética , Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Hospitales Urbanos/ética , Hospitales Urbanos/legislación & jurisprudencia , Humanos , Autonomía Personal , Suicidio Asistido/ética , Suicidio Asistido/legislación & jurisprudencia , Suicidio Asistido/tendencias , SuizaRESUMEN
In 2010 five New York City hospitals implemented a communication-and-resolution program (CRP) in general surgery. The program's goals were to improve reporting of serious adverse events to risk management, support clinical staff in discussing these events with patients, rapidly investigate why injuries occurred, communicate to patients what was discovered, and offer apologies and compensation when the standard of care was not met. We report the hospitals' experiences with implementing the CRP over a twenty-two-month period. We found that all five hospitals improved disclosure and surveillance of adverse events but were not able to fully implement the program's compensation component. These experiences suggest that strong support from top leadership at the hospital and insurer levels, and adequate staff resources, are critical for the success of CRPs. Hospitals considering adopting a CRP should ensure that their organizations can tolerate risk, their leaders are willing to reinforce CRP implementation, and resources are in place to educate clinical staff about how the program can benefit them.
Asunto(s)
Comunicación , Implementación de Plan de Salud/legislación & jurisprudencia , Hospitales Urbanos/legislación & jurisprudencia , Seguro de Responsabilidad Civil/legislación & jurisprudencia , Mala Praxis/legislación & jurisprudencia , Errores Médicos/legislación & jurisprudencia , Negociación , Compensación y Reparación/legislación & jurisprudencia , Humanos , Ciudad de Nueva York , Seguridad del Paciente/legislación & jurisprudencia , Gestión de Riesgos/legislación & jurisprudencia , Autorrevelación , Estados UnidosRESUMEN
UNLABELLED: Microbiological tests of air in hospitals are the very important constituent element in prophylaxis of health care-associated infections. The aim of the study is to assess air in hospitals accordingly to the microbiological standards. The results were analyzed for 1993-2011. There were 0.2-4.2% of the samples that did not meet the standard. The maximum amount of microorganisms was found while SanPiN 2.1.3.1375-03 was effective within validity period SanPiN 2.1.3.2630-10 didn't normalize fungus, resulting in the minimal amount of mold. The frequency of sampling did not affect the result. DISCUSSION: Moulds are the causative agents of invasive fungal infections. Fungi can cause nosocomial infections. There is description of method to isolate fungi in the guidelines for control MUK 4.2.2942-11. CONCLUSION: It is necessary to use a new procedure when assessing the air in hospitals.
Asunto(s)
Microbiología del Aire/normas , Contaminantes Atmosféricos/análisis , Contaminación del Aire Interior/análisis , Hospitales Urbanos/normas , Microbiota , Contaminación del Aire Interior/legislación & jurisprudencia , Contaminación del Aire Interior/prevención & control , Regulación Gubernamental , Hospitales Urbanos/legislación & jurisprudencia , Federación de RusiaRESUMEN
OBJECTIVES: Of the 1.1 million people in the United States infected with human immunodeficiency virus (HIV), more than 20% are unaware of their infection. To increase early diagnosis and treatment, New York State recently passed legislation mandating that HIV testing be offered to all patients, ages 13 to 64 years, receiving health care services. Implementation of this legislation is complex, especially in the emergency department (ED). This study explores ED providers' perceptions of the factors affecting the implementation of the law. METHODS: The authors conducted six focus group sessions and three in-depth interviews with ED health care providers from two New York City teaching hospitals. Sessions were audiotaped and transcribed. Data were coded and summarized thematically through an iterative process after each session. RESULTS: A total of 49 providers participated and data saturation was achieved. Six factors were identified that predispose a provider to offer an HIV test: 1) self-efficacy, 2) behavioral intention, 3) the testing process, 4) provider knowledge of the legislation, 5) type of HIV test, and 6) follow-up procedures. Five factors were identified that enable providers to offer an HIV test: 1) resources related to time, 2) space, 3) staff, 4) type of test, and 5) timing of the offer. Improving access to HIV testing, linkage to care, and public health were all key factors in reinforcing providers' desire to offer HIV tests. Concerns regarding overall cost saving and coverage for the test were indicated as barriers that needed to be resolved to reinforce the providers to offer an HIV test. CONCLUSIONS: Understanding the factors influencing the practice of ED providers charged with carrying out this mandate is critical. Despite earlier research that indicated that offering HIV testing to ED patients is largely influenced by cost, this study found additional factors that are important to consider to effectively implementing HIV testing in the ED.
Asunto(s)
Actitud del Personal de Salud , Servicio de Urgencia en Hospital/legislación & jurisprudencia , Infecciones por VIH/diagnóstico , Hospitales Urbanos/legislación & jurisprudencia , Exámenes Obligatorios/legislación & jurisprudencia , Cuerpo Médico de Hospitales/psicología , Serodiagnóstico del SIDA/métodos , Serodiagnóstico del SIDA/estadística & datos numéricos , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ciudad de Nueva York , Adulto JovenAsunto(s)
Actitud del Personal de Salud , Servicio de Urgencia en Hospital/legislación & jurisprudencia , Infecciones por VIH/diagnóstico , Hospitales Urbanos/legislación & jurisprudencia , Exámenes Obligatorios/legislación & jurisprudencia , Cuerpo Médico de Hospitales/psicología , Femenino , Humanos , MasculinoRESUMEN
OBJECTIVES: To link, from a historical point of view, the most significant transformations of the Instituto Materno Infantil (IMI) [the oldest child and maternity hospital of the country] during its process of crisis, closure and liquidation with the experiences of the hospital workers. To find experience-based and theoretical elements that can interconnect the process of health care privatization of the country with the workers' experiences of resistance and pain/suffering. METHODS: Critically-oriented ethnography based on continuous collective field work, historical research (primary and secondary sources) and semi-structured interviews with 5 women who worked at the IMI for more than 15 years. RESULTS: A time line of 4 main periods: Los años de gloria [The golden years] (up to 1990); Llega el neoliberalismo [Neoliberalism arrives] (1990-2000); La crisis y las resistencias [Crisis and resistances] (2001-2005); and Liquidación [Liquidation (2006-20??)]. The narratives of the interviewed women unveil multiple aggressions that have intensified since 2006, have caused pain and suffering and are examples of violations of human and labour rights. DISCUSSION: We suggest to analyze the links between the different kinds of violence and pain and suffering as torture. This category is defined as the set of violent actions that cause physical and emotional pain, which are performed by actors in positions of power over other people who challenge that power and are part of modern States' ideological principles around a defined moral social order. For the IMI workers' case, the ideological principle that is being challenged is health care neoliberalism. From the analyses of bureaucracy, confinement, torturing agents, and the breaking-off of the body-mind unit we conclude that this relationship between neoliberalism and torture aims to eliminate the last health care workers of the country who had job stability and full-benefits through public labour contracts. Their elimination furthers the accumulation of capital generated by increasing over-exploitation of labour and commodification of health care.
Asunto(s)
Empleo/legislación & jurisprudencia , Clausura de las Instituciones de Salud , Personal de Salud/psicología , Hospitales Urbanos/organización & administración , Centros de Salud Materno-Infantil/organización & administración , Política , Política Pública/legislación & jurisprudencia , Tortura , Desempleo/psicología , Colombia , Mercantilización , Contratos/legislación & jurisprudencia , Depresión/etiología , Depresión/psicología , Femenino , Clausura de las Instituciones de Salud/legislación & jurisprudencia , Hospitales Urbanos/economía , Hospitales Urbanos/legislación & jurisprudencia , Hospitales Urbanos/tendencias , Humanos , Satisfacción en el Trabajo , Masculino , Centros de Salud Materno-Infantil/economía , Centros de Salud Materno-Infantil/legislación & jurisprudencia , Centros de Salud Materno-Infantil/tendencias , Reducción de Personal/legislación & jurisprudencia , Reducción de Personal/psicología , Embarazo , Política Pública/tendencias , Salarios y Beneficios/legislación & jurisprudencia , Cambio Social , Suicidio/psicología , Tortura/psicologíaRESUMEN
The Emergency Medical Treatment and Labor Act was enacted in 1986 to prevent hospitals from turning away patients with emergency medical conditions, often because they were uninsured--a practice commonly known as "patient dumping." Twenty-five years later, Denver Health--a large, urban, safety-net hospital--continues to experience instances in which people with emergency conditions, many of whom are uninsured, end up in the safety-net setting after having been denied care or receiving incomplete care elsewhere. We present five case studies and discuss potential limitations in the oversight and enforcement of the 1986 law. We advocate for a more effective system for reporting and acting on potential violations, as well as clearer standards governing compliance with the law.
Asunto(s)
Servicio de Urgencia en Hospital/legislación & jurisprudencia , Hospitales Urbanos/legislación & jurisprudencia , Transferencia de Pacientes/legislación & jurisprudencia , Negativa al Tratamiento/legislación & jurisprudencia , Adulto , Centers for Medicare and Medicaid Services, U.S. , Colorado , Servicio de Urgencia en Hospital/economía , Femenino , Precios de Hospital , Humanos , Masculino , Pacientes no Asegurados/legislación & jurisprudencia , Persona de Mediana Edad , Estudios de Casos Organizacionales , Negativa al Tratamiento/estadística & datos numéricos , Atención no Remunerada/economía , Atención no Remunerada/estadística & datos numéricos , Estados UnidosRESUMEN
Objetivos Relacionar históricamente las transformaciones más significativas del Instituto Materno Infantil (IMI) en su proceso de crisis, cierre y liquidación con las experiencias de sus trabajadores/as. Encontrar elementos vivenciales y teóricos que interconecten el proceso de privatización de la salud con las experiencias de resistencia y dolor/sufrimiento de trabajadores/as. Métodos Etnografía inscrita en corrientes críticas y apoyada en trabajo de campo constante y colectivo, investigación histórica (fuentes primarias y secundarias) y entrevistas semiestructuradas con cinco mujeres que trabajaron por más de quince años en el IMI. Resultados Una línea del tiempo con cuatro periodos principales: Los años de gloria (hasta 1990), Llega el neoliberalismo (1990-2000), La crisis y las resistencias (2001-2005) y Liquidación (2006-). La narrativa de las mujeres entrevistadas devela múltiples agresiones que se intensificaron desde el 2006 generando dolor/ sufrimiento, relatos que ilustran violaciones a sus derechos humanos y laborales. Discusión Proponemos analizar las conexiones entre los diferentes tipos de violencia y el dolor/sufrimiento bajo la categoría tortura, entendida como acciones violentas que causan dolor físico-emocional, las cuales son ejecutadas por actores de poder sobre otros que desafían alterarlo. Enfatizamos en las burocracias, el confinamiento, los agentes torturadores y los resquebrajamientos a la unidad mente/cuerpo para argumentar que esta relación neoliberalismo y tortura pretende eliminar los últimos trabajadores/as de la salud del país con garantías laborales para avanzar en la acumulación de capital que genera la creciente sobreexplotación del trabajo y la mercantilización de la salud.
Objectives To link, from a historical point of view, the most significant transformations of the Instituto Materno Infantil (IMI) [the oldest child and maternity hospital of the country] during its process of crisis, closure and liquidation with the experiences of the hospital workers. To find experience-based and theoretical elements that can interconnect the process of health care privatization of the country with the workers' experiences of resistance and pain/suffering. Methods Critically-oriented ethnography based on continuous collective field work, historical research (primary and secondary sources) and semi-structured interviews with 5 women who worked at the IMI for more than 15 years.Results: A time line of 4 main periods: Los años de gloria [The golden years] (up to 1990); Llega el neoliberalismo [Neoliberalism arrives] (1990-2000); La crisis y las resistencias [Crisis and resistances] (2001-2005); and Liquidación [Liquidation (2006-20??)]. The narratives of the interviewed women unveil multiple aggressions that have intensified since 2006, have caused pain and suffering and are examples of violations of human and labour rights. Discussion We suggest to analyze the links between the different kinds of violence and pain and suffering as torture. This category is defined as the set of violent actions that cause physical and emotional pain, which are performed by actors in positions of power over other people who challenge that power and are part of modern States' ideological principles around a defined moral social order. For the IMI workers' case, the ideological principle that is being challenged is health care neoliberalism. From the analyses of bureaucracy, confinement, torturing agents, and the breaking-off of the body-mind unit we conclude that this relationship between neoliberalism and torture aims to eliminate the last health care workers of the country who had job stability and full-benefits through public labour contracts. Their elimination furthers the accumulation of capital generated by increasing over-exploitation of labour and commodification of health care.
Asunto(s)
Femenino , Humanos , Masculino , Embarazo , Empleo/legislación & jurisprudencia , Clausura de las Instituciones de Salud , Personal de Salud/psicología , Hospitales Urbanos/organización & administración , Centros de Salud Materno-Infantil/organización & administración , Política , Política Pública/legislación & jurisprudencia , Tortura , Desempleo/psicología , Colombia , Mercantilización , Contratos/legislación & jurisprudencia , Depresión/etiología , Depresión/psicología , Clausura de las Instituciones de Salud/legislación & jurisprudencia , Hospitales Urbanos/economía , Hospitales Urbanos/legislación & jurisprudencia , Hospitales Urbanos/tendencias , Satisfacción en el Trabajo , Centros de Salud Materno-Infantil/economía , Centros de Salud Materno-Infantil/legislación & jurisprudencia , Centros de Salud Materno-Infantil/tendencias , Reducción de Personal/legislación & jurisprudencia , Reducción de Personal/psicología , Política Pública/tendencias , Salarios y Beneficios/legislación & jurisprudencia , Cambio Social , Suicidio/psicología , Tortura/psicologíaRESUMEN
OBJECTIVE: Preterm delivery results in neonatal morbidity and mortality. We set out to estimate the difference in rates of preterm delivery in two institutions, serving a single population, with differing policies regarding use of tocolytic drugs for the prevention of preterm delivery. STUDY DESIGN: A retrospective study comparing preterm delivery rates between 2002 and 2007 in two large tertiary hospitals serving a single urban population with similar risk factor profile located less than 2 miles from each other. During the study period Hospital A routinely used tocolytic therapy, Hospital B operates a policy of never using any tocolytic drugs. Rates of delivery prior to 26, 30, 34 and 37 weeks were compared for each hospital. RESULTS: During the study period there were 90,843 deliveries between the two hospitals. The overall rates of preterm delivery at less than 37 weeks gestation were comparable with 6.62% (2794/42,232) in Hospital A and 6.15% (2989/48,611) in Hospital B (p = 0.99). There was no significant difference in the numbers delivering at less than 34 weeks, 995/42,232 (2.36%) versus 1134/48,611 (2.33%), p = 0.59, less than 30 weeks, 403/42,232 (0.95%) versus 429/48,611 (0.88%), p = 0.87 or prior to 26 weeks, 126/42,232 (0.29%) versus 121/48,611 (0.25%), p= 0.08. CONCLUSION: In this large population routine use of tocolytic drugs in the treatment of threatened preterm labor does not alter rates of early or late preterm delivery. While this study is limited by its retrospective nature, it calls into question the practice of tocolysis.
Asunto(s)
Trabajo de Parto Prematuro/epidemiología , Trabajo de Parto Prematuro/prevención & control , Nacimiento Prematuro/epidemiología , Nacimiento Prematuro/prevención & control , Práctica Profesional , Tocolíticos/uso terapéutico , Estudios de Cohortes , Femenino , Edad Gestacional , Hospitales Urbanos/legislación & jurisprudencia , Hospitales Urbanos/estadística & datos numéricos , Humanos , Recién Nacido , Enfermedades del Prematuro/epidemiología , Guías de Práctica Clínica como Asunto , Embarazo , Práctica Profesional/estadística & datos numéricos , Estudios Retrospectivos , Tocólisis/métodos , Población Urbana/estadística & datos numéricos , Vasotocina/análogos & derivados , Vasotocina/uso terapéuticoRESUMEN
CONTEXT: California is the first and only state to implement a patient-to-nurse ratio mandate for hospitals. Increasing nurse staffing is an important organizational intervention for improving patient outcomes. Evidence suggests that staffing improved in California hospitals after the mandate was enacted, but the outcome for hospitals bearing a disproportionate share of uncompensated care-safety-net hospitals-remains unclear. One concern was that California's mandate would burden safety-net hospitals without improving staffing or that hospitals would reduce their skill mix, that is, the proportion of registered nurses of all nursing staff. We examined the differential effect of California's staffing mandate on safety-net and non-safety-net hospitals. METHODS: We used a time-series design with Annual Hospital Disclosure data files from the California Office of Statewide Health Planning and Development (OSHPD) for the years 1998 to 2007 to assess differences in the effect of California's mandate on staffing outcomes in safety-net and non-safety-net hospitals. FINDINGS: The mandate resulted in significant staffing improvements, on average nearly a full patient per nurse fewer (-0.98) for all California hospitals. The greatest effect was in those hospitals with the lowest staffing levels at the outset, both safety-net and non-safety-net hospitals, as the legislation intended. The mandate led to significantly improved staffing levels for safety-net hospitals, although there was a small but significant difference in the effect on staffing levels of safety-net and non-safety-net hospitals. Regarding skill mix, a marginally higher proportion of registered nurses was seen in non-safety-net hospitals following the mandate, while the skill mix remained essentially unchanged for safety-net hospitals. The difference between the two groups of hospitals was not significant. CONCLUSIONS: California's mandate improved staffing for all hospitals, including safety-net hospitals. Furthermore, improvement did not come at the cost of a reduced skill mix, as was feared. Alternative and more targeted designs, however, might yield further improvement for safety-net hospitals and reduce potential disparities in the staffing and skill mix of safety-net and non-safety-net hospitals.
Asunto(s)
Hospitales de Condado/organización & administración , Hospitales Urbanos/organización & administración , Personal de Enfermería en Hospital/organización & administración , California , Hospitales de Condado/economía , Hospitales de Condado/legislación & jurisprudencia , Hospitales Urbanos/economía , Hospitales Urbanos/legislación & jurisprudencia , Humanos , Personal de Enfermería en Hospital/legislación & jurisprudencia , Personal de Enfermería en Hospital/estadística & datos numéricos , Personal de Enfermería en Hospital/provisión & distribución , Admisión y Programación de Personal/legislación & jurisprudencia , Pautas de la Práctica en Enfermería/economía , Pautas de la Práctica en Enfermería/legislación & jurisprudencia , Competencia Profesional , Análisis de Regresión , Atención no Remunerada/estadística & datos numéricosAsunto(s)
Barreras de Comunicación , Servicio de Urgencia en Hospital , Lenguaje , Relaciones Médico-Paciente , Dolor Abdominal/etiología , Adolescente , Brasil/etnología , Cuidadores/legislación & jurisprudencia , Cuidadores/psicología , Servicio de Urgencia en Hospital/legislación & jurisprudencia , Femenino , Hospitales Urbanos/legislación & jurisprudencia , Humanos , Consentimiento Informado/legislación & jurisprudencia , Anamnesis , Traducción , Estados UnidosRESUMEN
AIM: To describe how registered nurses (RNs) perceive delegation to unlicensed personnel (UP) in a municipal healthcare context in Sweden. BACKGROUND: Within municipal health care RNs often delegate tasks to UP. The latter have practical training, but lack formal competence. METHOD: Twelve RNs were interviewed and the material was analysed using a phenomenographic approach. RESULTS: Owing to a shortage of RNs, delegation is seen as a prerequisite for a functioning organization. This necessity also involves a number of perceived contradictions in three areas: (1) the work situation of RNs - facilitation and relief vs. lack of control, powerlessness, vagueness regarding responsibility, and resignation; (2) the relationship with unlicensed personnel - stimulation, possibility for mentoring, use of UP competence and the creation of fairness vs. questioning UP competence; and (3) The patients - increase in continuity, quicker treatment, and increased security vs. insecurity (with respect to, for example, the handling of medicine). CONCLUSION: Registered nurses perceptions of delegation within municipal healthcare involve their own work situation, the UP and the patients. IMPLICATIONS FOR NURSING MANAGEMENT: Registered nurses who delegate to UP must be given time for mentoring such that the nursing care is safe care of high quality.
Asunto(s)
Delegación Profesional/métodos , Hospitales Urbanos/estadística & datos numéricos , Enfermeras y Enfermeros/organización & administración , Personal de Enfermería en Hospital/organización & administración , Población Urbana/estadística & datos numéricos , Adulto , Competencia Clínica , Delegación Profesional/organización & administración , Eficiencia Organizacional , Femenino , Hospitales Urbanos/legislación & jurisprudencia , Hospitales Urbanos/organización & administración , Humanos , Masculino , Mentores , Persona de Mediana Edad , Modelos de Enfermería , Modelos Organizacionales , Enfermeras y Enfermeros/legislación & jurisprudencia , Investigación Cualitativa , Suecia , Carga de TrabajoAsunto(s)
Hospitales Urbanos/organización & administración , Sistemas Multiinstitucionales/organización & administración , Disentimientos y Disputas , Reestructuración Hospitalaria , Hospitales Urbanos/legislación & jurisprudencia , Humanos , Sistemas Multiinstitucionales/legislación & jurisprudencia , Negociación , OhioAsunto(s)
Negociación Colectiva/legislación & jurisprudencia , Programas de Inmunización/legislación & jurisprudencia , Personal de Enfermería en Hospital/legislación & jurisprudencia , Sociedades de Enfermería/legislación & jurisprudencia , Hospitales Urbanos/legislación & jurisprudencia , Humanos , Vacunas contra la Influenza/provisión & distribución , Gripe Humana/prevención & control , Programas Obligatorios , WashingtónRESUMEN
OBJECTIVE: Description of an outbreak of legionnaires' disease originating in one of the cooling towers of a hospital. PATIENTS AND METHODS: This study included patients with confirmed pneumonia caused by Legionella pneumophila serogroup 1 and related to the Vallcarca neighborhood of Barcelona (Spain) in August 2004. Exposure was determined by a standardized questionnaire. An environmental investigation was carried out to identify the source of the outbreak. A descriptive analysis including incidence rates estimation was performed, as well as molecular study to document the genetic identity among human and environmental strains. RESULTS: Thirty-three cases of L. pneumophila pneumonia were detected. Median age was 68 years and 70% of the affected patients were men. Incidence rate among residents in less than 200 meters of the source and older than 65 was 888.9 cases/100,000 inhabitants. Lethality rate was 6%. Four seasonal cooling towers that were not registered with the authorities were identified in a health care center. L. pneumophila was isolated from all four and at least one colony in each tower had the same genetic profile as the strains isolated from patients. CONCLUSIONS: An association was demonstrated between a community outbreak of legionellosis and unregistered seasonal cooling towers located in a hospital. All risk facilities should be registered and inspected to ensure that they fulfill current legislation requirements.