scholarly journals Reserved Bed Program Reduces Neurosciences Intensive Care Unit Capacity Strain: An Implementation Study

Neurosurgery ◽  
2019 ◽  
Vol 86 (1) ◽  
pp. 132-138
Author(s):  
Christopher D Shank ◽  
Nicholas J Erickson ◽  
David W Miller ◽  
Brittany F Lindsey ◽  
Beverly C Walters
Keyword(s):  
Intensive Care ◽  
Economies Of Scale ◽  
Negative Impact ◽  
The United States ◽  
Fiscal Year ◽  
Implementation Study ◽  
Service Line ◽  
Hospital Units ◽  
Significant Negative Impact ◽  
Operational Issues

Abstract BACKGROUND Neurosciences intensive care units (NICUs) provide institutional centers for specialized care. Despite a demonstrable reduction in morbidity and mortality, NICUs may experience significant capacity strain with resulting supraoptimal utilization and diseconomies of scale. We present an implementation study in the recognition and management of capacity strain within a large NICU in the United States. Excessive resource demand in an NICU creates significant operational issues. OBJECTIVE To evaluate the efficacy of a Reserved Bed Pilot Program (RBPP), implemented to maximize economies of scale, to reduce transfer declines due to lack of capacity, and to increase transfer volume for the neurosciences service-line. METHODS Key performance indicators (KPIs) were created to evaluate RBPP efficacy with respect to primary (strategic) objectives. Operational KPIs were established to evaluate changes in operational throughput for the neurosciences and other service-lines. For each KPI, pilot-period data were compared to the previous fiscal year. RESULTS RBPP implementation resulted in a significant increase in accepted transfer volume to the neurosciences service-line (P = .02). Transfer declines due to capacity decreased significantly (P = .01). Unit utilization significantly improved across service-line units relative to theoretical optima (P < .03). Care regionalization was achieved through a significant reduction in “off-service” patient placement (P = .01). Negative externalities were minimized, with no significant negative impact in the operational KPIs of other evaluated service-lines (P = .11). CONCLUSION Capacity strain is a significant issue for hospital units. Reducing capacity strain can increase unit efficiency, improve resource utilization, and augment service-line throughput. RBPP implementation resulted in a significant improvement in service-line operations, regional access to care, and resource efficiency, with minimal externalities at the institutional level.

scholarly journals Nutrition Support Protocols: Enhancing Delivery of Enteral Nutrition

2017 ◽  
Vol 37 (2) ◽  
pp. e15-e23 ◽  
Author(s):  
Colleen O’Leary-Kelley ◽  
Karen Bawel-Brinkley
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Enteral Nutrition ◽  
Best Practice ◽  
Negative Impact ◽  
Active Role ◽  
Nutrition Support ◽  
Intensive Care Patients ◽  
Improved Outcomes ◽  
Significant Negative Impact

In critical care, malnutrition has a significant, negative impact on a patient’s ability to respond to medical treatment. Enteral nutrition is known to counteract the metabolic changes associated with critical illness that increase the risk for serious complications and poor clinical outcomes. Inadequate delivery of nutrition support and underfeeding persist in intensive care units despite the availability of guidelines and current research for best practice. Recent studies have shown that nutrition support protocols are effective in promoting nutritional goals in a wide variety of intensive care patients. It is essential to find approaches that enhance early delivery of enteral nutrition that meets requirements and supports improved outcomes. Nurses are in a unique position to take an active role in promoting the best nutritional outcomes for their patients by using and evaluating nutrition support protocols.

scholarly journals Strategies to minimize readmission rates following major urologic surgery

2017 ◽  
Vol 9 (5) ◽  
pp. 111-119 ◽  
Author(s):  
Janet Baack Kukreja ◽  
Ashish M. Kamat
Keyword(s):  
Negative Impact ◽  
Early Discharge ◽  
The United States ◽  
Time Frame ◽  
Major Surgery ◽  
Readmission Rates ◽  
Urologic Oncology ◽  
Improve Symptom ◽  
Significant Negative Impact ◽  
Recovery Pathways

Readmissions after major surgical procedures are prevalent across multiple disciplines. Specifically, in urology, with incorporation of early discharge and recovery pathways, readmissions are emerging as an important problem and effecting an epidemic proportion of urology patients. As expected, readmissions have garnered the attention of major healthcare payers in the United States who see readmissions as easy targets because of the association with astronomical costs. More importantly, readmissions have a significant negative impact on patient sense of wellbeing, and places economic and other hardships on the doors of our patients and their families. Here, we explore the reasons patients are readmitted, using radical cystectomy as a case study, and means to decrease the incidence of readmissions. Since time to readmission for most major urologic oncology surgeries is within the first 2 weeks after discharge, this time frame is critical for efforts to improve symptom identification and reduce the total number and severity of readmissions. Readmission reduction to zero is unlikely for any major surgery, but with effective coordinated strategies, we must strive to reduce the rates as much as possible, as a means to improve the care continuum for our patients.

scholarly journals Labor Market Adjustment In High-Tech Industries: A Critical Review

2011 ◽  
Vol 11 (1) ◽  
pp. 1
Author(s):  
Amlan Mitra ◽  
Bhaskar J. Das
Keyword(s):  
Labor Market ◽  
Negative Impact ◽  
Local Level ◽  
Relevant Literature ◽  
The United States ◽  
High Tech ◽  
Significant Negative Impact ◽  
Occupational Composition ◽  
Social Debate ◽  
Labor Market Adjustment

Capitalist restructuring in the United States has been a key fore in reshaping cities and regions in the late 1970s and 1980s. The emergence of high-tech industries and its impact on the level of employment, the quality of work, and the condition of labor is at the core of the social debate over the high-tech led economic development. Some researchers argue that high-tech industries have a positive effect on labor markets. Others seem to support the idea of a significant negative impact exercised by high-technologies on employment patterns and occupational composition. The purpose of this paper is to provide some insights on this debate by critically examining the relevant literature. We conclude that there is a need to inquire further into the labor market adjustment at the local level to unravel the inner complexities.

Maternal Perinatal Depression in the Neonatal Intensive Care Unit: The Role of the Neonatal Nurse

2012 ◽  
Vol 31 (5) ◽  
pp. 295-304 ◽  
Author(s):  
Cara Bicking ◽  
Ginger A. Moore
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Perinatal Depression ◽  
Negative Impact ◽  
Neonatal Nurses ◽  
Developmental Problems ◽  
Significant Negative Impact

The onset of depressive symptoms during pregnancy or the first year postpartum, termed perinatal depression, occurs in approximately 15 percent of women. Perinatal depression can have a significant negative impact on health outcomes for the mother and her infant including maternal emotional distress and parenting difficulties and infant behavioral and developmental problems. Nurses caring for patients in the neonatal intensive care unit (NICU) are in a key position to affect positive change in the lives of families affected by perinatal depression. An overview of antepartum and postpartum depression is provided that has been tailored to the educational needs of the neonatal nurse. A discussion of the role of neonatal nurses in the identification and treatment of perinatal depression follows in order that neonatal nurses may improve both short- and long-term outcomes for mothers, infants, and families in the NICU affected by perinatal depression.

scholarly journals Mental Retirement

2010 ◽  
Vol 24 (1) ◽  
pp. 119-138 ◽  
Author(s):  
Susann Rohwedder ◽  
Robert J Willis
Keyword(s):  
Instrumental Variables ◽  
Early Retirement ◽  
Negative Impact ◽  
Causal Effect ◽  
The United States ◽  
Substantial Body ◽  
Labor Force Status ◽  
Retirement Behavior ◽  
Significant Negative Impact ◽  
Cross Country

Early retirement appears to have a significant negative impact on the cognitive ability of people in their early 60s that is both quantitatively important and causal. We obtain this finding using cross-nationally comparable survey data from the United States, England, and Europe that allow us to relate cognition and labor force status. We argue that the effect is causal by making use of a substantial body of research showing that variation in pension, tax, and disability policies explain most variation across countries in average retirement rates. (In an informal manner, we are arguing that public policies that affect the age of retirement may be used as instrumental variables to generate cross-country variation in retirement behavior in order to identify the causal effect of retirement on cognition.)

scholarly journals Specific aspects of indian foreign policy: stagnation and changes

2020 ◽  
Vol 3 (5) ◽  
pp. 55-64
Author(s):  
Rano Tuychiyeva Almamatovna
Keyword(s):  
United States ◽  
Foreign Policy ◽  
Main Part ◽  
Negative Impact ◽  
The United States ◽  
External Factors ◽  
Significant Negative Impact ◽  
Internal And External Factors ◽  
Indian Foreign Policy ◽  
Positive Results

This article focuses on how India organized its foreign policy from the time of independence until the beginning of the 21st century and on the basis of which strategies it pursued. The paper also examines in detail the internal and external factors that have helped the country to achieve effective, positive results in foreign policy and, conversely, have had a significant negative impact. In addition, the article pays special attention to India's relations with the United States, China and Russia, which are currently striving for global hegemony, and the competition between these countries in India. At the same time, the successes, shortcomings and conflicts in India’s relations with its neighbors - Pakistan, Bangladesh, Myanmar, Nepal and Bhutan - are highlighted, as well as their specific reasons. Chronological approach, comparison and synthesis-analysis methods were used in writing the article. It consists of an abstract, keywords, introduction, main part, conclusion and bibliography.

scholarly journals Supply of immigrant entrepreneurs and native entrepreneurship

2021 ◽  
Vol 12 (1) ◽  
Author(s):  
Keshar M. Ghimire
Keyword(s):  
Least Squares ◽  
Negative Impact ◽  
The United States ◽  
Ordinary Least Squares ◽  
Self Employment ◽  
Immigrant Entrepreneurs ◽  
Significant Negative Impact ◽  
State Variation ◽  
Nationally Representative ◽  
Least Squares Estimates

Abstract Using nationally representative data from the United States, the author estimates the causal impact of immigrant entrepreneurship on entrepreneurial propensities of natives. The author draws data from the Annual Social and Economic Supplement of the Current Population Survey and uses within-state variation in supply of immigrant entrepreneurs for identification. To address concerns of endogeneity in the supply of immigrant entrepreneurs, the author takes advantage of a quasi-experiment provided by the State Children's Health Insurance Program. While the Ordinary Least Squares estimates indicate a positive effect, the Two Stage Least Squares estimates suggest that, on average, there is no significant effect of immigrant entrepreneurs on native entrepreneurship. Moreover, there is no net effect on subgroups of natives separated by skill level. There is also some evidence that immigrant entrepreneurs may “crowd-in” Blacks into certain types of self-employment. These results are in contrast to the significant negative impact suggested by the previous literature.

scholarly journals Effects of Internal Factors on Financial Performance of Joint Venture Banks in Nepal

2019 ◽  
Vol 12 (1) ◽  
pp. 87-99
Author(s):  
Deepesh Ranabhat
Keyword(s):  
Financial Performance ◽  
Joint Venture ◽  
Negative Impact ◽  
Positive Impact ◽  
Capital Adequacy ◽  
Annual Reports ◽  
Fiscal Year ◽  
Interest Rate Spread ◽  
Significant Negative Impact ◽  
The Impact

 This paper examines the impact of bank specific variables on financial performance of joint venture banks. The return on assets and return on equity are selected as bank’s performance variables for this study and these two are the dependent variables. Spread rate, size of assets, loan, deposit, liquidity and capital adequacy ratio of the firms are the independent variables. The data are collected from supervision report of Nepal Rastra Bank and annual reports of concerned six banks for 10 years from fiscal year 2008/09 to 2017/18.The pooled OLS multiple regression models are applied to test the significance and effects of bank specific variable on financial performance of Nepalese Joint Venture Banks. The result shows that there is a significant positive impact of interest rate spread on ROA and ROE of the banks. Similarly, there is significant negative impact of asset size on ROA and significant negative impact of liquidity and loan ratio on ROE of the banks.

scholarly journals The Management of Electro-Medical Equipment in Intensive Care Units: Assurance of Traceability and Metrological Reliability

2019 ◽  
Vol 2 (2) ◽  
pp. 70-74
Author(s):  
Juliana Lins de Oliveira ◽  
Herman Augusto Lepikson
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
United States Of America ◽  
Medical Equipment ◽  
Rapid Evolution ◽  
Health Sector ◽  
The United States ◽  
Metrological Reliability ◽  
Hospital Units ◽  
Metrological Parameters

Physiological measurements in the health sector have been supported by the rapid evolution of medical equipment technologies. The health sector increasingly requires the development of mechanisms and applications that assure the metrological reliability of the results obtained using the equipment for the diagnosis, treatment, and monitoring of the clinical evolution of patients. This study demonstrates the weaknesses in the control of metrological parameters related to electro-medical equipment (EMS) in Brazil, specifically those used in Intensive Care Units (ICU), where reliability is critical in terms of survival, sequelae or death. We discuss essential determinants to ensure physiological measurements, such as the limitations of legislation/standards, laboratory infrastructure, voluntary accreditations, including a brief history and indicators of patient safety in Brazil and the United States of America, as well as data from research at Hospital Units (HUs) located in Salvador, Bahia, Brazil.

Health Communication: Implications for Diverse Populations

2011 ◽  
Vol 18 (1) ◽  
pp. 12-19
Author(s):  
Amy Hasselkus
Keyword(s):  
Health Care ◽  
Health Communication ◽  
Negative Impact ◽  
Linguistically Diverse ◽  
Good Health ◽  
The United States ◽  
Poor Health ◽  
Health Care Decisions ◽  
Diverse Backgrounds ◽  
Health Related

The need for improved communication about health-related topics is evident in statistics about the health literacy of adults living in the United States. The negative impact of poor health communication is huge, resulting in poor health outcomes, health disparities, and high health care costs. The importance of good health communication is relevant to all patient populations, including those from culturally and linguistically diverse backgrounds. Efforts are underway at all levels, from individual professionals to the federal government, to improve the information patients receive so that they can make appropriate health care decisions. This article describes these efforts and discusses how speech-language pathologists and audiologists may be impacted.

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