personnel staffing and scheduling

Background: Background: Nursing care is known to improve patient outcomes during hospitalization, but the mechanisms by which outcomes are improved have not been fully explicated. Continuity in nursing care (CINC) may be an important characteristic of nursing care delivery that impacts patient outcomes. However, evidence linking CINC to patient outcomes is limited. Purpose: The first aim of this study was to Purpose: The first aim of this study was to examine the relationship between CINC and patient outcomes -length of intensive care unit (ICU) stay, examine the relationship between CINC and patient outcomes -length of intensive care unit (ICU) stay, duration of mechanical ventilation, adverse events, and ICU-acquired infections -in a pediatric ICU. The duration of mechanical ventilation, adverse events, and ICU-acquired infections -in a pediatric ICU. The second aim was to examine whether the match of nursing expertise to mortality risk enhances the second aim was to examine whether the match of nursing expertise to mortality risk enhances the relationship between CINC and patient outcomes. relationship between CINC and patient outcomes. Methods: Methods: This cross-sectional study was a secondary This cross-sectional study was a secondary data analysis of prospectively collected data that were merged from multiple databases from one data analysis of prospectively collected data that were merged from multiple databases from one pediatric ICU.

Rationale and Objectives. Diagnostic ultrasound examinations may be performed after-hours by physicians if technologists are not available or cases are complex. Our experience suggested there is wide variability in how ultrasound coverage is provided after-hours, which motivated us to conduct a formal survey of teaching programs around the country. Methods. Four hundred five members of the Association of Program Directors in Radiology were contacted by e-mail and sent a link to a five-part questionnaire posted on the Web. Respondents were asked whether ultrasound cases after-hours are performed in their institutions by radiology residents, technologists on the premises after-hours, technologists on-call, or some combination. Data on the type of program, number of beds in the primary hospital, number of residents in the program, and geographic location of the program were recorded. Responses were automatically written to a data file stored on a Web server and the imported into an Excel spreadsheet for data analysis. A 2 analysis was performed to assess associations among the variables and statistical significance. Results. A total of 79 programs responded to the survey. Of those, 32% provided coverage with ultrasound technologists on call, 24% by ultrasound technologists on the premises, 13% provided combination coverage, and 10% provided coverage solely with residents on call. There was no association among number of residents in the program, location of the program, or type of program (university, community, or affiliated) and type of coverage provided. There is wide variability in methods for providing coverage of after-hours ultrasound cases. However, on-site or on-call coverage of emergency cases by technologists did not appear to depend significantly on program location, program type, or program size.

Exploring nursing skill mix: a review Aims The overall aims of the paper are to provide an overview of the subject, illustrate the need for further research and to raise awareness of the ongoing limitations of existing knowledge and present these to those involved in skill mix decision making. Background Over the last 20 years health care organizations across the globe have seen an increase in the pace of change. The continuing drive towards cost-effectiveness, quality of care and the clinical governance agenda are causing more and more managers to examine closely the mix of staff skills. This paper demonstrates that, despite 20 years of research and skill mix management in practice, there continues to be a tension between the use of qualified and unqualified staff, particularly, the cost and quality dimensions. Conclusion The evidence which currently exists offers some limited support for the suggestion that redistribution of certain tasks in nursing could be possible and could contribute to strategies for meeting the demands of changes within health care delivery. Any reallocation of task, and substitution of qualified by unqualified staff, should be based on sound evidence and not merely on staff availability, service demand or apparent costs.

To examine the interrelationship among behavioral health clinician (BHC) staffing, scheduling, and a primary care practice's approach to delivering integrated care. Methods: Observational cross-case comparative analysis of 17 primary care practices in the United States focused on implementation of integrated care. Practices varied in size, ownership, geographic location, and integrated care experience. A multidisciplinary team analyzed documents, practice surveys, field notes from observation visits, implementation diaries, and semistructured interviews using a grounded theory approach. Results: Across the 17 practices, staffing ratios ranged from 1 BHC covering 0.3 to 36.5 primary care clinicians (PCCs). BHC scheduling varied from 50-minute prescheduled appointments to open, flexible schedules slotted in 15-minute increments. However, staffing and scheduling patterns generally clustered in 2 ways and enabled BHCs to be engaged by referral or warm handoff. Five practices predominantly used warm handoffs to engage BHCs and had higher BHC-to-PCC staffing ratios; multiple BHCs on staff; and shorter, more flexible BHC appointment schedules. Staffing and scheduling structures that enabled warm handoffs supported BHC engagement with patients concurrent with the identification of behavioral health needs. Twelve practices primarily used referrals to engage BHCs and had lower BHCto-PCC staffing ratios and BHC schedules prefilled with visits. This enabled some BHCs to bill for services, but also made them less accessible to PCCs in when patients presented with behavioral health needs during a clinical encounter. Three of these practices were experimenting with open scheduling and briefer BHC visits to enable real-time access while managing resources. Conclusion: Practices' approaches to PCC-BHC staffing, scheduling, and delivery of integrated care mutually influenced each other and were shaped by the local context. Practice leaders, educators, clinicians, funders, researchers, and policy makers must consider these factors as they seek to optimize integrated systems of care. (J Am Board Fam Med 2015;28:S32-S40.

Service or Provider Names Features Assessment Methods Results Improved Metrics Choose and Book [1-3]  UK national appointment system for National Health Service (NHS)  Supports Web-based appointments  Supports electronic referrals Retrospective analysis of patient attendance data. [2] Appointments booked with "Choose and Book" had a significantly lower no-show rate than those made by traditional appointment methods. This system optimized the referral process, reduced delays, and streamlined outpatient referral pathways.

Pediatric Critical Care Medicine is proud to present translations of selected abstracts into Chinese, French, Italian, Japanese, Portuguese, and Spanish. We sincerely thank the following for their important work on these translations: Xun-mei Fan, MD

Communication breakdowns have been identified as a source of problems in complex work settings such as hospital-based healthcare. The authors conducted a multi-method study of change of shift handoffs between nurses, including interviews, survey, audio taping and direct observation of handoffs, posthandoff questionnaires, and archival coding of clinical records. The authors found considerable variability across units, nurses and, surprisingly, roles. Incoming and outgoing nurses had different expectations for a good handoff: incoming nurses wanted a conversation with questions and eye contact, whereas outgoing nurses wanted to tell their story without interruptions. More experienced nurses abbreviated their reports when incoming nurses knew the patient, but the incoming nurses responded with a large number of questions, creating a contest for control. Nurses' ratings did not correspond to expert ratings of information adequacy, suggesting that nurses consider other functions of ...

This article presents and discusses a model for describing and evaluating the principal risk factors characterising occupational exposure: frequency and repetitiveness of movements, use of force, type of posture and movements, distribution of recovery periods, presence of other influential (complementary) factors. For each risk factor, the authors propose a method of practical detection in the field, as well as criteria for classifying and interpreting the results based on a critical review of the available literature on the subject. Numerous examples are supplied to better illustrate the concepts presented. The various factors considered are classified using numbers or indexes, so that they can be integrated into a concise exposure index described by the authors elsewhere in this volume.

The purpose of this study was to explore whether sleep-related cardiac sympathetic activity is significantly lower in rotating shift workers than in permanent night shift workers, in order to evaluate whether shift work is preferable to permanent night work. Our sample comprised of twelve permanent night shift nurses and twelve rotating three-shift nurses. All female nurses slept in their dormitories, where they were allowed to sleep and wake spontaneously. All sleep parameters were recorded and analyzed using an ambulatory polysomnographic recorder. No significant differences were identified between permanent night shift (PNS) nurses and rotating three-shift (RTS) nurses in terms of basic demographics and sleep patterns. The low frequency (LF) of PNS nurses was significantly higher than that of RTS nurses during both daytime sleep and wakefulness, as was the low-to-high frequency ratio (LF/HF) during both nighttime sleep and wakefulness. PNS nurses also exhibited significantly higher LF and LF/HF during the first to third episode of non-rapid eye movement (NREM1-3) sleep, and the first episode of rapid-eye movement (REM1) sleep. PNS nurses had higher sympathetic activity during nighttime and daytime sleep than did RTS nurses. These results suggest that a rotating three-shift schedule may be preferable to permanent night work in terms of cardiac autonomic regulation.

The purpose of this study was to explore whether sleep-related cardiac sympathetic activity is significantly lower in rotating shift workers than in permanent night shift workers, in order to evaluate whether shift work is preferable to permanent night work. Our sample comprised of twelve permanent night shift nurses and twelve rotating three-shift nurses. All female nurses slept in their dormitories, where they were allowed to sleep and wake spontaneously. All sleep parameters were recorded and analyzed using an ambulatory polysomnographic recorder. No significant differences were identified between permanent night shift (PNS) nurses and rotating three-shift (RTS) nurses in terms of basic demographics and sleep patterns. The low frequency (LF) of PNS nurses was significantly higher than that of RTS nurses during both daytime sleep and wakefulness, as was the low-to-high frequency ratio (LF/HF) during both nighttime sleep and wakefulness. PNS nurses also exhibited significantly higher LF and LF/HF during the first to third episode of non-rapid eye movement (NREM1-3) sleep, and the first episode of rapid-eye movement (REM1) sleep. PNS nurses had higher sympathetic activity during nighttime and daytime sleep than did RTS nurses. These results suggest that a rotating three-shift schedule may be preferable to permanent night work in terms of cardiac autonomic regulation.

p = 0.002), and sterilizations (p ! 0.001) than the 2003 graduates. The above findings were unchanged when evaluating procedures for which the resident was the primary surgeon. Duty-hour restrictions have not adversely affected the operative experience of obstetrics and gynecology residents. No significant differences in the number of the spontaneous vaginal deliveries, abdominal hysterectomies, or vaginal hysterectomies performed were observed.

Background-Few studies have examined factors associated with antidepressant prescribing in older nursing home residents. Objective-The primary objective was to describe the change in antidepressant prescribing for nursing home residents between 1996 and 2006. An additional objective was to examine the association between any change in antidepressant prescribing and staffing patterns or coprescribing of other psychotropic medications in the same cohort. Settings-Settings were 12,556 US nursing homes in 1996 and 2006. Data Sources-Online Survey Certification and Reporting (OSCAR) data and the Area Resource File (ARF). Results-Antidepressant prescribing significantly increased (P < .05) from 21.9% in 1996 to 47.5% in 2006. After controlling for resident, organizational, and market factors, increased antidepressant prescribing was associated with more time spent by physician extenders (adjusted odds ratio [AOR] 2.21; 95% confidence interval [CI] 1.96-2.51), registered nurses (AOR 1.06, 95% CI 1.02-1.10), or nurse aides (AOR 1.08; 95%CI 1.04-1.12) in a facility, as well as the coprescribing of sedative/hypnotics (AOR 1.12; 95% CI 1.08-1.16). Factors found to be protective of increasing antidepressant prescribing (ie, decrease antidepressant prescribing) included having medical directors and physicians spend more time in the facility (AOR 0.60; 95%

To determine whether the use of a designated staff person to coordinate and schedule therapy services in a postacute residential rehabilitation program for people with acquired brain lesions results in (1) a higher-intensity treatment and a reduced length of stay; (2) reduced rehabilitation costs; and (3) increased patient and staff satisfaction. This nonrandomized retrospective study from 2009 through 2012 uses data collected relative to 2 different methods of scheduling: (1) self-planning, in which each single team member makes appointments that are then displayed on a shared board; and (2) managed planning, in which appointments are made by a designated staff person. A residential center for people with postacute acquired brain lesions. Patients (N=20) with acquired brain lesions who had similar clinical and demographic characteristics comprised the managed planning group (n=10) and the self-planning group (n=10). Not applicable. Organizational measures (length of stay in rehabil...

Objective: The European Working Time Regulations (EWTR) have been criticized for its purported negative impact on the training of junior doctors. The aim of this study was to examine the amount of time interns spent engaging in various work activities. Design: An online time-use diary was used to collect data from interns. Setting: Two teaching hospitals in the Republic of Ireland. Participants: A total of 45 interns logged at least one 24-h period. The logs were obtained from 67 shifts from a surgical rotation and 83 shifts from a medical rotation. Main Outcome Measures: The amount of time interns spent engaging in direct patient care, indirect patient care, educational activities and personal activities. Results: On day shift, medical interns spent a significantly smaller proportion of the shift on direct care (159/613 min, 25.9% versus 214/636 min, 33.6%) and a greater proportion on education (195/613 min, 31.8% versus 139/636 min, 21.9%) than surgical interns. On extended days, medical interns spent a significantly larger proportion of the shift on education than surgical interns (243/ 814 min, 29.9% versus 126/804, 15.7% min). On night shift, medical interns spent a significantly greater proportion of the shift on direct care (590/720 min, 81.9% versus 346/727 min, 47.6%) and education (33/720 min, 4.6% versus 6/727 min, 0.8%) than surgical interns. Conclusions: The interns in the study reported spending more time on direct patient care and educational activities, and less time on indirect patient care activities than interns in other countries.

The European Working Time Regulations (EWTR) have been criticized for its purported negative impact on the training of junior doctors. The aim of this study was to examine the amount of time interns spent engaging in various work activities. An online time-use diary was used to collect data from interns. Two teaching hospitals in the Republic of Ireland. A total of 45 interns logged at least one 24-h period. The logs were obtained from 67 shifts from a surgical rotation and 83 shifts from a medical rotation. The amount of time interns spent engaging in direct patient care, indirect patient care, educational activities and personal activities. On day shift, medical interns spent a significantly smaller proportion of the shift on direct care (159/613 min, 25.9% versus 214/636 min, 33.6%) and a greater proportion on education (195/613 min, 31.8% versus 139/636 min, 21.9%) than surgical interns. On extended days, medical interns spent a significantly larger proportion of the shift on ed...

Historically, mandatory overtime has been used to provide adequate staffing in times of crisis; however, as a result of today's severe nursing shortage, hospitals and other healthcare institutions are more commonly using mandatory overtime as a daily management tool to meet staffing requirements. This practice has created turmoil between management and staff in providing quality healthcare. Nursing literature describing staff nurses' views of overtime is limited. This article offers a description of the environment at the Hospital for Sick Children, a private nonprofit rehabilitation and transitional care pediatric hospital in Washington, DC, and the challenges the hospital faces in staffing the patient care units. This article also reports the results of the hospital's efforts to poll the nursing staff on their opinions regarding both voluntary and mandatory overtime and identifies conditions that influence the nursing staff's decisions and perceptions about overtime. Survey results will be used to modify existing staffing strategies and implement new staffing policies.

Introduction: There is an increasing demand for intensive care in hospitals, which can lead to capacity limitations in the intensive care unit (ICU). Due to postponement of elective surgery or delayed admission of emergency patients, outcome may be negatively influenced. To optimize the admission process to intensive care, the postanaesthesia care unit (PACU) was staffed with intensivist coverage around the clock. The aim of this study is to demonstrate the impact of the PACU on the structure of ICU-patients and the contribution to overall hospital profit in terms of changes in the case mix index for all surgical patients. Methods: The administrative data of all surgical patients (n = 51,040) 20 months prior and 20 months after the introduction of a round-the-clock intensivist staffing of the PACU were evaluated and compared. The relative number of patients with longer length of stay (LOS) (more than seven days) in the ICU increased after the introduction of the PACU. The average monthly number of treatment days of patients staying less than 24 hours in the ICU decreased by about 50% (138.95 vs. 68.19 treatment days, P <0.005). The mean LOS in the PACU was 0.45 (± 0.41) days, compared to 0.27 (± 0.2) days prior to the implementation. The preoperative times in the hospital decreased significantly for all patients. The case mix index (CMI) per hospital day for all surgical patients was significantly higher after the introduction of a PACU: 0.286 (± 0.234) vs. 0.309 (± 0.272) P <0.001 CMI/hospital day. The introduction of a PACU and the staffing with intensive care staff might shorten the hospital LOS for surgical patients. The revenues for the hospital, as determined by the case mix index of the patients per hospital day, increased after the implementation of a PACU and more patients can be treated in the same time, due to a better use of resources.

Meaningfully recognizing the extraordinary contributions of nurses is a key element in creating and sustaining healthy work environments. Publically honoring the work of nursing reinforces those actions and behaviors that patients, families, and colleagues truly value. A multi-site research study provided a 360-degree perspective of the impact this type of acknowledgment had on strengthening the nursing workforce at 20 health care organizations who use The DAISY Award to recognize extraordinary nurses. Data analysis of 2,195 DAISY Award nominations from patients, families, and colleagues at 20 hospitals identified 22 behavioral themes associated with extraordinary nursing.

Aim: To explore aged care staff perceptions and experience of their relationships with co-workers, older people and families via pragmatic exploratory interviews. Methods: Thirty-nine direct care staff from seven residential age care facilities and 12 community organisations were interviewed. Results: Staff felt that their capacity to develop therapeutic relationships with older people and families was impeded by care tasks and concerns regarding professional boundaries. Positive relationships between staff-family and staff-staff are hindered by staff perceptions of undue care demands, high family expectations, and staff-staff conflict within a hierarchical context and between work shifts. Conclusion: A relationship-centred approach to care as well as staff training and education should be encouraged to assist the development of therapeutic relationships and the management of professional boundaries.

Background-Providing equitable and patient-centered care is critical to ensuring high quality of care. Although racial/ethnic disparities in quality are widely reported for nursing facilities, it is unknown whether disparities exist in consumer experiences with care and how public reporting of consumer experiences affects facility performance and potential racial disparities. Methods-We analyzed trends of consumer ratings publicly reported for Maryland nursing homes during 2007-2010, and determined whether racial/ethnic disparities in experiences with care changed during this period. Multivariate longitudinal regression models controlled for important facility and county characteristics and tested changes overall and by facility groups (defined based on concentrations of black residents). Consumer ratings were reported for: overall care; recommendation of the facility; staff performance; care provided; food & meals; physical environment; and autonomy & personal rights. Results-Overall ratings on care experience remained relatively high (mean=8.3 on a one-to-ten scale) during 2007-2010. Ninety percent of survey respondents each year would recommend the facility to someone who needs nursing home care. Ratings on individual domains of care improved among all nursing homes in Maryland (p<0.01) except for food & meals (p=0.827 for trend). However, site-of-care disparities existed in each year for overall ratings, recommendation rate, and ratings on all domains of care (p<0.01 in all cases), with facilities more predominated by black residents having lower scores; such disparities persisted over time (p>0.2 for trends in disparities). Maryland nursing homes showed maintained or improved consumer ratings during the first 4 years of public reporting, gaps persisted between facilities with high versus low concentrations of minority residents.

Objective-The occurrence of pressure ulcers (PUs) in nursing homes (NHs) is a marker for poor quality of care. We examine whether differences in PU prevalence between Black and White residents are due to within-or across-facility disparities. Minimum Data Sets are linked with the Online Survey Certification and Reporting (OSCAR) database. Long-term care (LTC) residents with high risk for PUs are identified. The dependent variable is dichotomous, indicating PU presence/absence. Individual race and facility race-mix are the main variables of interests. The sample includes 59,740 LTC high-risk residents (17.4% black & 82.6% white) in 619 NHs. We fit three risk-adjusted logit models: base, conditional fixed-effects, and random-effects. Results-Unadjusted PU prevalence is 14.5% (18.2% for Blacks and 13.8% for Whites). Overall, Blacks are more likely to have PUs than Whites, controlling for individual risk factors. We find no such effect within facilities after additional controlling for facility fixed effect. The effect of race is significantly different between the base and the conditional fixed-effects logit model. The random-effects and conditional fixed-effects logit models show similar results, demonstrating that higher PU presence among Blacks is associated with greater facility-specific concentration of Black residents. PU occurrence among Blacks may not result from differential withinfacility treatment of Blacks versus Whites. Rather, Blacks are more likely to reside in facilities with poorer care quality. To improve PU care for Blacks, efforts should focus on improving the overall quality of care for facilities with high proportion of Black residents.

Recent increases in state Medicaid payments to nursing homes have the potential to reduce disparities in nurse staffing between facilities with high and low concentrations of racial/ethnic minority residents. Analyses of nursing home and state policy survey data for the period 2001-11 suggest that registered nurse and licensed practical nurse staffing levels increased slightly during this period, regardless of racial/ethnic minority resident concentration. Adjusted disparities in registered nurse hours per resident day between nursing homes with high and low concentrations of minority residents persisted, although they were reduced. Certified nursing assistant hours per patient day increased in nursing homes with low concentrations of minorities but decreased in homes with high concentrations, creating a new disparity. Overall, increases in state Medicaid payment rates to nursing homes were associated with improvements in staffing and reduced staffing disparities across facilities, ...

Despite the increased use of nursing homes by minority residents, nursing home care remains highly segregated. Compared to whites, racial/ethnic minorities tend to be cared for in facilities with limited clinical and financial resources, low nurse staffing levels, and a relatively high number of care deficiency citations. We assessed the trends from 2006 to 2011 in those citations and in disparities across facilities with four different concentrations of racial/ethnic minority residents. We found that the number of health care-related deficiencies and the percentage of facilities with serious deficiencies decreased over time for all four facility groups. From 2006 to 2011 the average annual number of health care-related deficiencies declined from 7.4 to 6.8 for facilities with low minority concentrations (&lt;5 percent) and from 10.6 to 9.4 for facilities with high minority concentrations (≥35 percent). In multivariable analyses, across-site disparities in health care-related defici...

Objective-The occurrence of pressure ulcers (PUs) in nursing homes (NHs) is a marker for poor quality of care. We examine whether differences in PU prevalence between Black and White residents are due to within-or across-facility disparities. Minimum Data Sets are linked with the Online Survey Certification and Reporting (OSCAR) database. Long-term care (LTC) residents with high risk for PUs are identified. The dependent variable is dichotomous, indicating PU presence/absence. Individual race and facility race-mix are the main variables of interests. The sample includes 59,740 LTC high-risk residents (17.4% black & 82.6% white) in 619 NHs. We fit three risk-adjusted logit models: base, conditional fixed-effects, and random-effects. Results-Unadjusted PU prevalence is 14.5% (18.2% for Blacks and 13.8% for Whites). Overall, Blacks are more likely to have PUs than Whites, controlling for individual risk factors. We find no such effect within facilities after additional controlling for facility fixed effect. The effect of race is significantly different between the base and the conditional fixed-effects logit model. The random-effects and conditional fixed-effects logit models show similar results, demonstrating that higher PU presence among Blacks is associated with greater facility-specific concentration of Black residents. PU occurrence among Blacks may not result from differential withinfacility treatment of Blacks versus Whites. Rather, Blacks are more likely to reside in facilities with poorer care quality. To improve PU care for Blacks, efforts should focus on improving the overall quality of care for facilities with high proportion of Black residents.

Objective:  To obtain a 2005 snapshot of New Zealand (NZ) rural primary health care workforce, specifically GPs, general practice nurses and community pharmacists. Design:  Postal questionnaires, November 2005. Setting:  NZ‐wide rural general practices and community pharmacies. Participants:  Rural general practice managers, GPs, nurses, community pharmacy managers and pharmacists. Main outcome measures:  Self‐reported data: demographics, country of training, years in practice, business ownership, hours worked including on‐call, intention to leave rural practice. Results:  General practices: response rate 95% (206/217); 70% GP‐owned, practice size ranged from one GP/one nurse to 12 GPs/nine nurses. Pharmacies:  Response rate 90% (147/163). Majority had one (33%) or two (32%) pharmacists; &lt;10% had more than three pharmacists. GPs: response rate 64% (358/559), 71% male, 73% aged &gt;40, 61% full‐time, 79% provide on‐call, 57% overseas‐trained, 78% male and 57% female GPs aged &gt;4...

OBJECTIVES: A pragmatic cluster RCT investigated the effectiveness of a pharmacist-led information technology-enabled (PINCER) intervention in reducing risk of medication errors, in England. General practices were randomised to computer-generated simple feedback audit reports on at-risk patients (control) or the PINCER intervention comprising feedback, educational outreach and dedicated support from a pharmacist (intervention). We compared the costs and benefits of the PINCER intervention versus control. METHODS: Costs (English NHS perspective), QALYs and net benefit were generated. Error rates and intervention costs (corrected for baseline) were combined with modelled projected harm and NHS cost, adjusted for proportion of each error. Probabilistic Markov models were constructed to quantify the economic impact of each medication error (NSAIDs, beta-blockers, ACE-inhibitors, diuretics, amiodarone, methotrexate, lithium). A five year time horizon was used. Costs and outcomes were discounted at 3.5%. RESULTS: Seventy-two practices (480942 patients) were randomised to either arm. Mean (SD) error rate reduction per practice (simple feedback vs PINCER) at 6 months was 12.90 (0.26) (p<0.001). In deterministic analysis, PINCER was dominant, generating 0.81 more QALYs and saving £2611 per practice. In probabilistic analysis, PINCER reached 57% probability of being cost-effective at £10000 ceiling willingness-to-pay (λ). The probability of PINCER being cost-effective had not increased beyond 57% at λ: £30000. The mean net benefit generated (λ: £30000) was £21 (SD £91). Practice size did not affect results. CONCLUSIONS: This is one of the first studies to estimate the economic impact of a safety-focused intervention in health care. In the basecase, PINCER is dominant. However, due to uncertainty around the clinical and economic consequences of some errors, PINCER could not be considered cost-effective under current decision rules. Correcting errors relating to certain drugs (NSAIDs and amiodarone) had more impact, such that PINCER may be cost-effective if the "right" errors are targeted. Future work will investigate including other errors.

In the changing modern economy some new factors have been addressed that are of importance for productivity and economic growth, such as human skills, workplace organization, information and communication technologies (ICT) and knowledge sharing. An increasing number of companies and organizations are implementing measures to better address these factors, often referred to as &#39;the New Ways of Working (NWW)&#39;. This consists of a large variety of measures that enable flexibility in the time and location of work. Expectations of these measures are often high, such as a reduction in operating costs and an increase of productivity. However, scientific proof is still lacking, and it is worth asking whether al these implementations actually cause a change in work behavior and effect business outcomes positively. This article describes a case study of three departments (total of 73 employees) that changed from a traditional way of working towards a new way of working. Questionnaires ...

Objectives To investigate the prevalence of Carpal Tunnel Syndrome (CTS) in full-time and part-time supermarket cashiers exposed to a diVerent weekly duration of biomechanical load. Methods All the 269 cashiers and 127 oYce workers were asked to participate. The protocol included ergonomic risk assessment, collection of personal and clinical data and bilateral electrodiagnostic study of the median nerve. CTS symptoms were deWned as past and/or current nocturnal and/or diurnal numbness, tingling, burning or pain involving at least one of the Wrst three Wngers. Results were evaluated according to two case deWnitions based on current symptoms and on the combination of current symptoms and slowing of sensory conduction velocity from wrist to palm, respectively. DiVerence in proportions of CTS symptoms and cases was evaluated by the Pearson's chi-square ( 2 ) test, univariate and multivariate logistic regression analyses were performed to determine the impact of weekly exposure. Results The Wnal female study population included 71 full-time cashiers, 155 part-time cashiers and 98 oYce workers. Ergonomic risk level was rated 5 for hand activity level and 4 for peak of force according to ACGIH. The intersection of the two values fell on the threshold limit value line, conWrming the possible exposure to biomechanical risk factors for CTS. The prevalence of current CTS symptoms was higher among full-time (31.0%) than in part-time cashiers (19.3%) or controls (16.3%) (p = 0.055). A similar pattern was found for CTS past symptoms and cases. Univariate analysis showed that full-time cashiers had a 2.3 fold increased risk for CTS speciWc current symptoms than control subjects. A similar trend also emerged for CTS cases but was not signiWcant (Odds ratios 1.23). Multivariate logistic regression analysis conWrmed the increased risk for CTS current symptoms in full-time cashiers. Conclusions Intensive manual work associated with inadequate recovery time might have generated an impairment of the median nerve at the wrist level proportionally increasing with duration of hand use. Our study can provide useful information both for ergonomic risk assessment and work organization.

To develop a model for estimating the services and human resources needed to care for people with severe psychiatric conditions in a hypothetical population of 100,000 people in South Africa. Annual mental health service needs were estimated in terms of numbers of daily patient visits (DPV) in ambulatory care, the number of beds required, and staffing. Developed within a spreadsheet format, the model allows for the adjustment of key service variables according to estimated or existing service data. At 100% coverage, 87 DPV, 28 acute beds, and 10 medium-long stay beds are necessary for a population of 100,000 people. This would require 35.2 full-time equivalent mental health staff: 21.3 for inpatient care, 12.0 for ambulatory care, and 1.9 for management. Because the model can produce a range of service recommendations, the assumptions that inform it should be clearly stated and justified. This method makes the assumptions on which services are planned explicit and allows for a ratio...

Nationally, medical schools are appointing growing numbers of research faculty into non-tenure-track positions, paralleling a similar trend in universities. The American Association of University Professors (AAUP) issued a statement expressing concern that the marked growth in non-tenure-track faculty can undermine educational quality, academic freedom, and collegiality. Like other medical schools, the UC Davis School of Medicine has had a rise in non-tenure-track faculty in order to enhance its research mission, in particular in the Salaried Adjunct faculty track (SalAdj). SalAdj faculty have more difficulty in achieving promotion, report inequitable treatment and less quality of life, have less opportunity to participate in governance, and feel second-class and insecure. These issues reflect those described by the AAUP. The authors describe the efforts at UC Davis to investigate and address these issues, implementation of a plan for improvement based on task force recommendations, and the lessons learned. Supporting transfer to faculty tracks in the academic senate, enhancing financial support, ensuring eligibility for internal grants, and equitable space assignments have contributed to an improved career path and more satisfaction among SalAdj faculty. Challenges in addressing these issues include limited availability of tenure-track positions, financial resources, adequate communication regarding change, and compliance with existing faculty search policies.

The objective of this study was to demonstrate the association between nurse staffing and adverse events at the shift level. Background: Despite a growing body of research linking nurse staffing and patient outcomes, the relationship of staffing to patient falls and medication errors remains equivocal, possibly due to dependence on aggregated data. Methods: Thirteen military hospitals participated in creating a longitudinal nursing outcomes database to monitor nurse staffing, patient falls and medication errors, and other outcomes. Unit types were analyzed separately to stratify patient and nurse staffing characteristics. Bayesian hierarchical logistic regression modeling was used to examine associations between staffing and adverse events. Results: RN skill mix, total nursing care hours, and experience, measured by a proxy variable, were associated with shift-level adverse events. Conclusions: Consideration must be given to nurse staffing and experience levels on every shift. Although the preponderance of research linking nurse staffing to patient safety is compelling, 1-3 there are limitations in the available evidence. A comprehensive review of studies published before 2004 showed that ample evidence exists of an inverse relationship between nurse staffing and both failure to rescue and inpatient mortality. 2 Authors of the review cite Bimprobable[ associations between nurse staffing and 15 other patient outcomes, including pressure ulcers, patient falls, and treatment errors, 2(p329) and mixed evidence for relationships between nurse staffing and illnesses such as pneumonia and urinary tract infections. Despite equivocal evidence, nurse-sensitive quality measures are increasingly important in healthcare public reporting and pay-for-performance. Furthermore, regulatory interventions such as California's landmark 1999 legislation mandating minimum nurse staffing ratios have occurred in the absence of empirical data to prescribe staffing levels that ensure patient safety. The ambiguity in the staffing-outcomes literature may be a result of varied sources of available data, different levels of analysis, and other methodological

The objective of this study was to demonstrate the association between nurse staffing and adverse events at the shift level. Background: Despite a growing body of research linking nurse staffing and patient outcomes, the relationship of staffing to patient falls and medication errors remains equivocal, possibly due to dependence on aggregated data. Methods: Thirteen military hospitals participated in creating a longitudinal nursing outcomes database to monitor nurse staffing, patient falls and medication errors, and other outcomes. Unit types were analyzed separately to stratify patient and nurse staffing characteristics. Bayesian hierarchical logistic regression modeling was used to examine associations between staffing and adverse events. Results: RN skill mix, total nursing care hours, and experience, measured by a proxy variable, were associated with shift-level adverse events. Conclusions: Consideration must be given to nurse staffing and experience levels on every shift. Although the preponderance of research linking nurse staffing to patient safety is compelling, 1-3 there are limitations in the available evidence. A comprehensive review of studies published before 2004 showed that ample evidence exists of an inverse relationship between nurse staffing and both failure to rescue and inpatient mortality. 2 Authors of the review cite Bimprobable[ associations between nurse staffing and 15 other patient outcomes, including pressure ulcers, patient falls, and treatment errors, 2(p329) and mixed evidence for relationships between nurse staffing and illnesses such as pneumonia and urinary tract infections. Despite equivocal evidence, nurse-sensitive quality measures are increasingly important in healthcare public reporting and pay-for-performance. Furthermore, regulatory interventions such as California's landmark 1999 legislation mandating minimum nurse staffing ratios have occurred in the absence of empirical data to prescribe staffing levels that ensure patient safety. The ambiguity in the staffing-outcomes literature may be a result of varied sources of available data, different levels of analysis, and other methodological

Objective. To identify the benefits and consequences of having part-time faculty members in departments of pharmacy practice from the department chair's perspective. Methods. A stratified purposive sample of 12 pharmacy practice department chairs was selected. Eleven telephone interviews were conducted. Two investigators independently read interview notes and categorized and enumerated responses to determine major themes using content analysis. The investigators jointly reviewed the data and came to consensus on major themes. Results. Benefits of allowing full-time faculty members to reduce their position to part-time included faculty retention and improved individual faculty work/life balance. Consequences of allowing part-time faculty positions included the challenges of managing individual and departmental workloads, the risk of marginalizing part-time faculty members, and the challenges of promotion and tenure issues. All requests to switch to part-time status were faculty-driven and most were approved. Conclusions. There are a variety of benefits and consequences of having part-time faculty in pharmacy practice departments from the chair's perspective. Clear faculty and departmental expectations of part-time faculty members need to be established to ensure optimal success of this working arrangement.

Objective The purpose of this study was to investigate how psychiatry programs are addressing the new Accreditation Council for Graduate Medical Education (ACGME) training requirements regarding transitions in patient care effective July 1, 2011. Methods An anonymous online survey was distributed to program directors of general psychiatry residencies within the USA. Survey questions pertaining to the 2011 ACGME handoff requirements focused on training modalities, assessment of competence, and oversight of appropriate handoff procedures. In addition, program directors were asked to share specific challenges in implementing the new handoff regulations as well as their view on how the new regulations would impact patient care. Results Of the 177 recipients, 108 completed at least part of the survey (61 % response rate). Only 11.4 % of programs indicated that they did not need to make any changes to their program in order to meet the new guidelines. Approximately a third of survey respondents reported that they did not yet have a formal curriculum in handoffs (32.4 %) and/or did not specifically assess competence at handoffs (30.5 %). Program directors cited the challenge of working with a variety of clinical settings with unique cultures, infrastructure, and policies and procedures and suggested that implementation and ownership of handoff training and assessment should be at the level of the clinical services. Despite these challenges, most program directors agreed that the new ACGME requirements would improve patient care and safety. Conclusions The high frequency of programs without established handoff curricula or competence evaluations highlights the potential value of published resources and tools to provide standardized training and assessment in handoffs. The results also underscore the importance of developing training and assessment in close collaboration with the clinical services and recognizing the need to tailor handoff communications to address the types of transitions that occur within each clinical setting.

This study aims to analyze the production of knowledge about Planning and Sizing of the Health Workforce (PDFTS) developed in Brazil, identifying models and methodologies that consider the Guidelines of the Unified Health System (SUS) for the constitution of regionalized care networks. This is an integrative review, including Brazilian studies and full text, in Portuguese, and available in the CAPES, BVS and Google Scholar databases. The searches returned 48,083 documents and, after selection with the PRISMA strategy, 62 studies published between 2011 and 2020 were included. Most of the analyzed productions approach the PDFTS with comparative analyzes between the estimated needs and the current availability, being more frequent the studies of only one professional category, with emphasis on nursing. The findings contribute to the debate on the essentiality of the health workforce for the conformation of networks, by demonstrating that the calculation methods favor the use of indicators and parameters related to the provision of services in specific health facilities, especially hospitals, not operationalizing aspects of regionalization and systemic integration of the Health Care Network. KEYWORDS Personnel downsizing. Health workforce. Health planning. Regional health planning. disponibilidade atual, sendo mais frequentes os estudos de apenas uma categoria profissional, com destaque para a enfermagem. Os achados contribuem à promoção do debate sobre a essencialidade da força de trabalho em saúde para a conformação das redes, ao demonstrar que os métodos de cálculo privilegiam o uso de indicadores e parâmetros relacionados à oferta de serviços em estabelecimentos de saúde específicos, especialmente hospitais, não operacionalizando aspectos de regionalização e integração sistêmica da Rede de Atenção à Saúde. Dimensionamento dos recursos humanos. Recursos humanos em saúde. Planejamento em saúde. Regionalização.

Extracorporeal cardiopulmonary resuscitation (ECPR) is a lifesaving rescue therapy for patients with refractory cardiac arrest. Previous studies suggest that maintaining a 24/7 in-house surgical team may reduce ECPR initiation time and improve survival in adult patients. However, an association between cardiac arrest occurring during off-hours and ECPR outcome has not been established in children. This is a single institution, retrospective review of all pediatric patients who received ECPR from December 2008 to August 2015. During the study period, ECPR was performed 54 times in 53 patients (20 weekday, 34 night/weekend). Interval from ECPR activation to initiation of extracorporeal life support was significantly longer during night/weekends (49min night/weekend vs. 33min weekday, p&lt;0.001) as was the interval from ECPR activation to incision for cannulation (26min night/weekend vs. 14min Weekday, p&lt;0.001). Rate of central nervous system (CNS) injury was higher in the night/we...

Cardiovascular diseases (CVDs) are known to be associated with poor sleep quality in general populations, but they have not been consistently associated with specific work schedules. Studies of CVD generally do not simultaneously consider sleep and work schedules, but that approach could help to disentangle their effects. We investigated the association between insomnia and a self-reported physician diagnosis of CVD in day and night workers, considering all sleep episodes during nocturnal and diurnal sleep. A cross-sectional study was conducted in 1307 female nursing professionals from 3 public hospitals, using baseline data from the &quot;Health and Work in Nursing - a Cohort Study.&quot; Participants were divided into two groups: i) day workers with no previous experience in night shifts (n=281) and whose data on insomnia were related to nocturnal sleep and ii) those who worked exclusively at night (n=340) and had data on both nocturnal and diurnal sleep episodes, as they often sl...

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We would also like to record our thanks to the Western Australian Mining Occupational Safety and Health Advisory Board (MOSHAB) for making the data from their Safety Behaviour Survey (2002) available to us. Finally, we are grateful to Russell Parks (MOSHAB), Keith Barker (QMC) and Ian Williams (Chair, CSRM Advisory Board) for their timely and helpful comments on a draft of this report.