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Naik H, Murray TM, Khan M, Daly-Grafstein D, Liu G, Kassen BO, Onrot J, Sutherland JM, Staples JA. Population-Based Trends in Complexity of Hospital Inpatients. JAMA Intern Med 2024; 184:183-192. [PMID: 38190179 PMCID: PMC10775081 DOI: 10.1001/jamainternmed.2023.7410] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/11/2023] [Indexed: 01/09/2024]
Abstract
Importance Clinical experience suggests that hospital inpatients have become more complex over time, but few studies have evaluated this impression. Objective To assess whether there has been an increase in measures of hospital inpatient complexity over a 15-year period. Design, Setting and Participants This cohort study used population-based administrative health data from nonelective hospitalizations from April 1, 2002, to January 31, 2017, to describe trends in the complexity of inpatients in British Columbia, Canada. Hospitalizations were included for individuals 18 years and older and for which the most responsible diagnosis did not correspond to pregnancy, childbirth, the puerperal period, or the perinatal period. Data analysis was performed from July to November 2023. Exposure The passage of time (15-year study interval). Main Outcomes and Measures Measures of complexity included patient characteristics at the time of admission (eg, advanced age, multimorbidity, polypharmacy, recent hospitalization), features of the index hospitalization (eg, admission via the emergency department, multiple acute medical problems, use of intensive care, prolonged length of stay, in-hospital adverse events, in-hospital death), and 30-day outcomes after hospital discharge (eg, unplanned readmission, all-cause mortality). Logistic regression was used to estimate the relative change in each measure of complexity over the entire 15-year study interval. Results The final study cohort included 3 367 463 nonelective acute care hospital admissions occurring among 1 272 444 unique individuals (median [IQR] age, 66 [48-79] years; 49.1% female and 50.8% male individuals). Relative to the beginning of the study interval, inpatients at the end of the study interval were more likely to have been admitted via the emergency department (odds ratio [OR], 2.74; 95% CI, 2.71-2.77), to have multimorbidity (OR, 1.50; 95% CI, 1.47-1.53) and polypharmacy (OR, 1.82; 95% CI, 1.78-1.85) at presentation, to receive treatment for 5 or more acute medical issues (OR, 2.06; 95% CI, 2.02-2.09), and to experience an in-hospital adverse event (OR, 1.20; 95% CI, 1.19-1.22). The likelihood of an intensive care unit stay and of in-hospital death declined over the study interval (OR, 0.96; 95% CI, 0.95-0.97, and OR, 0.81; 95% CI, 0.80-0.83, respectively), but the risks of unplanned readmission and death in the 30 days after discharge increased (OR, 1.14; 95% CI, 1.12-1.16, and OR, 1.28; 95% CI, 1.25-1.31, respectively). Conclusions and Relevance By most measures, hospital inpatients have become more complex over time. Health system planning should account for these trends.
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Affiliation(s)
- Hiten Naik
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Tyler M. Murray
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Mayesha Khan
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Daniel Daly-Grafstein
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Department of Statistics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Guiping Liu
- Center for Health Services and Policy Research (CHSPR), School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Barry O. Kassen
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jake Onrot
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jason M. Sutherland
- Center for Health Services and Policy Research (CHSPR), School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Advancing Health Outcomes, Vancouver, British Columbia, Canada
| | - John A. Staples
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Clinical Epidemiology & Evaluation (C2E2), Vancouver, British Columbia, Canada
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Mank VM, Wiggins A, Lowe D, Breighner C. Evaluation of an Education-based Training Orientation for Resident Physicians in an Intensive Care Unit in Hawai'i. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2022; 81:223-227. [PMID: 35923384 PMCID: PMC9344538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The need for multidisciplinary teams to provide complex care has increased as the population ages. As these teams become increasingly integrated, the knowledge, skills, and attitudes of resident physicians to practice safe and effective care in intensive care units (ICUs) evolves. A structured and multidisciplinary orientation day for resident physicians was implemented to assess improvements in physician confidence at Tripler Army Medical Center in Hawai'i from July 2019 to June 2020. ICU residents received an orientation day from a multidisciplinary team, with an emphasis on practical knowledge for common disease processes in a system-based fashion and competency in procedural skills. A total of 30 residents were asked to complete a pre- and post- orientation survey over a 1-year period, with 17 pre and post surveys completed for a response rate of 57%. The survey measured residents' perceived confidence in various tasks. Scores were compared using a paired 2-sampled t-test to assess statistical significance. The majority of resident physicians (76%) had at least 1 month of prior ICU experience. Statistically significant improvement was seen in self-reported abilities in performing 6 of the 10 elements assessed. With the diverse pathophysiology in critical care, it was essential to create a broad orientation with didactic and simulation-based learning, which resulted in observed improvement in more than half of the areas of interest. Adopting an orientation day for resident physicians rotating through the ICU can improve resident physician confidence, review important knowledge and skills, and highlight the role of each contributing multidisciplinary team member.
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Affiliation(s)
- Victoria M.F. Mank
- Department of Internal Medicine, Tripler Army Medical Center, Honolulu, HI (VMFM, CB)
| | - Amanda Wiggins
- Department of Pulmonary and Critical Care, Emory University, Atlanta, GA (AW)
| | - Derek Lowe
- Bassett Army Community Hospital, 1-24 IN 1/25 SBCT, Ft. Wainwright, AK (DL)
| | - Crystal Breighner
- Department of Internal Medicine, Tripler Army Medical Center, Honolulu, HI (VMFM, CB)
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Nelson RE, Richards JB, Ricotta DN. Strategies to elevate whiteboard mini lectures. CLINICAL TEACHER 2022; 19:79-85. [PMID: 35247030 DOI: 10.1111/tct.13479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 02/01/2022] [Accepted: 02/18/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Ryan E Nelson
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Jeremy B Richards
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Daniel N Ricotta
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Carl J. Shapiro Institute for Education and Research, Boston, MA, USA
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Akavipat P, Suraseranivongse S, Yimrattanabowon P, Sriraj W, Ratanachai P, Summart U. Anesthesia workforce capacity in Thailand: A multicenter study. WHO South East Asia J Public Health 2022; 10:5-11. [PMID: 35046151 DOI: 10.4103/who-seajph.who-seajph_305_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Workforce management in anesthesia services is crucial for service quality. However, the data associated with this are lacking. Therefore, this study was done to analyze workforce and workload and to compare differences among hospital clusters in Thailand. Materials and Methods We conducted a cross-sectional study in multilevel hospitals that were classified by location, the population cared for, and the categorization of physicians. Stratified randomization from all health service regions across Thailand was done. The profile of hospitals, number of anesthesia staffs, their capabilities, and ratio of anesthesia personnel to the service provided during the 5 workdays and 1 weekend period were analyzed. Results A total of 18 hospitals, ranging from secondary to super-tertiary referral centers, were included in the study. The mean number of personnel ranged from 2.0 ± 1.2 to 12.0 ± 0 for anesthesiologists and 7.5 ± 2.9 to 42.3 ± 19.3 for nurse anesthetists from each hospital cluster, which vary in terms of capabilities and the number of staff. The average number of anesthesia service units was 9.1 ± 4.2 to 31.9 ± 16.4, while the number of operating theaters was 6.9 ± 2.2 to 22.7 ± 8.3. However, the ratio of anesthesia personnel to one anesthesia service unit and the ratio of these personnel to an operating theater were not significantly different among the participating hospitals, with a mean of 0.94 ± 0.45 and 1.34 ± 0.38, respectively. Conclusion The overall number of anesthesia service units was above the designated operating theater capacity, while the ratio of anesthesiologists was 0.8-1.3 and nurse anesthetists was 2.4-6.5 per 100,000 people on an average, with a disproportionate responsibility ratio of anesthesia personnel to anesthesia service units during that time.
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Affiliation(s)
- Phuping Akavipat
- Anesthesiology Department, Neurological Institute of Thailand, Bangkok, Thailand
| | | | | | - Wimonrat Sriraj
- Department of Anesthesiology and Clinical Epidemiology Unit, Khon Kaen University, Khon Kaen, Thailand
| | - Prapa Ratanachai
- Department of Anesthesiology, Hatyai Hospital, Songkla, Thailand
| | - Ueamporn Summart
- Anesthesiology Department, Neurological Institute of Thailand, Bangkok, Thailand
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Huddles and their effectiveness at the frontlines of clinical care: a scoping review. J Gen Intern Med 2021; 36:2772-2783. [PMID: 33559062 PMCID: PMC8390736 DOI: 10.1007/s11606-021-06632-9] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/17/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Brief, stand-up meetings known as huddles may improve clinical care, but knowledge about huddle implementation and effectiveness at the frontlines is fragmented and setting specific. This work provides a comprehensive overview of huddles used in diverse health care settings, examines the empirical support for huddle effectiveness, and identifies knowledge gaps and opportunities for future research. METHODS A scoping review was completed by searching the databases PubMed, EBSCOhost, ProQuest, and OvidSP for studies published in English from inception to May 31, 2019. Eligible studies described huddles that (1) took place in a clinical or medical setting providing health care patient services, (2) included frontline staff members, (3) were used to improve care quality, and (4) were studied empirically. Two reviewers independently screened abstracts and full texts; seven reviewers independently abstracted data from full texts. RESULTS Of 2,185 identified studies, 158 met inclusion criteria. The majority (67.7%) of studies described huddles used to improve team communication, collaboration, and/or coordination. Huddles positively impacted team process outcomes in 67.7% of studies, including improvements in efficiency, process-based functioning, and communication across clinical roles (64.4%); situational awareness and staff perceptions of safety and safety climate (44.6%); and staff satisfaction and engagement (29.7%). Almost half of studies (44.3%) reported huddles positively impacting clinical care outcomes such as patients receiving timely and/or evidence-based assessments and care (31.4%); decreased medical errors and adverse drug events (24.3%); and decreased rates of other negative outcomes (20.0%). DISCUSSION Huddles involving frontline staff are an increasingly prevalent practice across diverse health care settings. Huddles are generally interdisciplinary and aimed at improving team communication, collaboration, and/or coordination. Data from the scoping review point to the effectiveness of huddles at improving work and team process outcomes and indicate the positive impact of huddles can extend beyond processes to include improvements in clinical outcomes. STUDY REGISTRATION This scoping review was registered with the Open Science Framework on 18 January 2019 ( https://osf.io/bdj2x/ ).
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Morris GA, Vaz K, Russo J, Karg K, Maltz RM, Mahan JD, Start AR. Implementing mini-chalk talks to enhance teaching and learning. CLINICAL TEACHER 2021; 18:577-582. [PMID: 34240813 DOI: 10.1111/tct.13394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Grant A Morris
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Karla Vaz
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - John Russo
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Kayla Karg
- Office of Curriculum and Scholarship, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Ross M Maltz
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Center of Microbial Pathogenesis, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - John D Mahan
- Nationwide Children's Hospital Center for Faculty Development, Division of Nephrology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Amanda R Start
- Office of Curriculum and Scholarship, The Ohio State University College of Medicine, Columbus, OH, USA
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Fajardo R, Vaporciyan A, Starnes S, Erkmen CP. Implementation of wellness into a cardiothoracic training program: A checklist for a wellness policy. J Thorac Cardiovasc Surg 2020; 161:1979-1986. [PMID: 32868064 DOI: 10.1016/j.jtcvs.2020.04.186] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 04/21/2020] [Accepted: 04/23/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Romulo Fajardo
- Department of General Surgery, Temple University Hospital, Philadelphia, Pa.
| | - Ara Vaporciyan
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, Houston, Tex
| | - Sandra Starnes
- Division of Thoracic Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Cherie P Erkmen
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pa
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Schlegel P, Kist AM, Semmler M, Döllinger M, Kunduk M, Dürr S, Schützenberger A. Determination of Clinical Parameters Sensitive to Functional Voice Disorders Applying Boosted Decision Stumps. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE 2020; 8:2100511. [PMID: 32518739 PMCID: PMC7274815 DOI: 10.1109/jtehm.2020.2985026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/21/2020] [Accepted: 03/28/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Various voice assessment tools, such as questionnaires and aerodynamic voice characteristics, can be used to assess vocal function of individuals. However, not much is known about the best combinations of these parameters in identification of functional dysphonia in clinical settings. METHODS This study investigated six scores from clinically commonly used questionnaires and seven acoustic parameters. 514 females and 277 males were analyzed. The subjects were divided into three groups: one healthy group (N01) (49 females, 50 males) and two disordered groups with perceptually hoarse (FD23) (220 females, 96 males) and perceptually not hoarse (FD01) (245 females, 131 males) sounding voices. A tree stumps Adaboost approach was applied to find the subset of parameters that best separates the groups. Subsequently, it was determined if this parameter subset reflects treatment outcome for 120 female and 51 male patients by pairwise pre- and post-treatment comparisons of parameters. RESULTS The questionnaire "Voice-related-quality-of-Life" and three objective parameters ("maximum fundamental frequency", "maximum Intensity" and "Jitter Percent") were sufficient to separate the groups (accuracy ranging from 0.690 (FD01 vs. FD23, females) to 0.961 (N01 vs. FD23, females)). Our study suggests that a reduced parameter subset (4 out of 13) is sufficient to separate these three groups. All parameters reflected treatment outcome for patients with hoarse voices, Voice-related-quality-of-Life showed improvement for the not hoarse group (FD01). CONCLUSION Results show that single parameters are insufficient to separate voice disorders but a set of several well-chosen parameters is. These findings will help to optimize and reduce clinical assessment time.
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Affiliation(s)
- Patrick Schlegel
- Department of Otorhinolaryngology Head and Neck SurgeryDivision of Phoniatrics and Pediatric AudiologyUniversity Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg91054ErlangenGermany
| | - Andreas M. Kist
- Department of Otorhinolaryngology Head and Neck SurgeryDivision of Phoniatrics and Pediatric AudiologyUniversity Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg91054ErlangenGermany
| | - Marion Semmler
- Department of Otorhinolaryngology Head and Neck SurgeryDivision of Phoniatrics and Pediatric AudiologyUniversity Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg91054ErlangenGermany
| | - Michael Döllinger
- Department of Otorhinolaryngology Head and Neck SurgeryDivision of Phoniatrics and Pediatric AudiologyUniversity Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg91054ErlangenGermany
| | - Melda Kunduk
- Department of Communication Sciences and DisordersLouisiana State UniversityBaton RougeLA70803USA
| | - Stephan Dürr
- Department of Otorhinolaryngology Head and Neck SurgeryDivision of Phoniatrics and Pediatric AudiologyUniversity Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg91054ErlangenGermany
| | - Anne Schützenberger
- Department of Otorhinolaryngology Head and Neck SurgeryDivision of Phoniatrics and Pediatric AudiologyUniversity Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg91054ErlangenGermany
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Capsule Commentary on Ratcliffe et al., "Service and Education: the Association Between Workload, Patient Complexity, and Teaching on Internal Medicine Inpatient Services". J Gen Intern Med 2018; 33:495. [PMID: 29423625 PMCID: PMC5880786 DOI: 10.1007/s11606-018-4338-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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