Investigating the level of functional preparedness of selected Tehran hospitals in the face of biological events: a focus on COVID-19

Purpose This study aims to evaluate the functional readiness of selected hospitals in Tehran in the face of biological events focusing on the Coronavirus. Design/methodology/approach The current study is a cross-sectional, descriptive-analytical study, with the research population consisting of four hospitals in Tehran (Ministry of Health, Social Security, Azad and Military University). This study used data collection tools, standardized functional preparedness tools for hospitals using a biological approach and a standardized checklist of biological event preparations for the American Hospital Association. Interviews with the incident and disaster committee director and observation of each hospital’s existing documents, were used to collect data, which was then analyzed using SPSS-16 software. Findings According to the results, the average percentage of total hospital preparedness in biological events is 36.9%. With 53.3%, the selected military hospital has the most preparation, whereas the Ministry of Health has the lowest preparation with 28.3%. Surge capacity management and communication had the most remarkable preparedness rate of 68.75% (adequate preparedness), biological consultants, meeting management and post-disaster recovery had the lowest preparedness rate of 0% (extremely weak preparedness). Practical implications The average functional preparedness of selected hospitals in Tehran was assessed at an insufficient level in this study. Given the recurrence of disease waves, these results are helpful in increasing hospital preparedness for impending events. Improving preparedness in most areas, especially in post-disaster recovery seems necessary. Originality/value Given the COVID-19 pandemic, it is important to assess hospitals’ readiness to increase capacity and respond to this scourge. Few studies have been done in this field in the world. This study investigates this issue in the capital of Iran. The finding of this study suggest authorities’ attention to this issue and the creation of severe and prompt solutions and measures and the use of military hospital experiences to improve biological threat preparedness.

Use of Palliative Care Among Commercially Insured Patients With Metastatic Cancer Between 2001 and 2016

PURPOSE: Early palliative care, concomitant with disease-directed treatments, is recommended for all patients with advanced cancer. This study assesses population-level trends in palliative care use among a large cohort of commercially insured patients with metastatic cancer, applying an expanded definition of palliative care services based on claims data. METHODS: Using nationally representative commercial insurance claims data, we identified patients with metastatic breast, colorectal, lung, bronchus, trachea, ovarian, esophageal, pancreatic, and liver cancers and melanoma between 2001 and 2016. We assessed the annual proportions of these patients who received services specified as, or indicative of, palliative care. Using Cox proportional hazard models, we assessed whether the time from diagnosis of metastatic cancer to first encounter of palliative care differed by demographic characteristics, socioeconomic factors, or region. RESULTS: In 2016, 36% of patients with very poor prognosis cancers received a service specified as, or indicative of, palliative care versus 18% of those with poor prognosis cancers. Being diagnosed in more recent years (2009-2016 v 2001-2008: hazard ratio [HR], 1.8; P < .001); a diagnosis of metastatic esophagus, liver, lung, or pancreatic cancer, or melanoma ( v breast cancer, eg, esophagus HR, 1.89; P < .001); a greater number of comorbidities (American Hospital Formulary Service classes > 10 v 0: HR, 1.71; P < .001); and living in the Northeast (HR, 1.43; P < .001) or Midwest ( v South: HR, 1.39; P < .001) were the strongest predictors of shorter time from diagnosis to palliative care. CONCLUSION: Use of palliative care among commercially insured patients with advanced cancers has increased since 2001. However, even with an expanded definition of services specified as, or indicative of, palliative care, < 40% of patients with advanced cancers received palliative care in 2016.

Registered nurses: can our supply meet the demand during a disaster?

Background Death and destructions are often reported during natural disasters; yet little is known about how hospitals operate during disasters and if there are sufficient resources available for hospitals to provide ongoing care during these catastrophic events. The purpose of this study was to determine if the State of New Jersey had a supply of registered nurses (RNs) that was sufficient to meet the needs of hospitalized patients during a natural disaster – Hurricane Sandy. Methods Secondary data were used to forecast the demand and supply of New Jersey RNs during Hurricane Sandy. Data sources from November 2011 and 2012 included the State Inpatient Databases (SID), American Hospital Association (AHA) Annual Survey on hospital characteristics and staffing data from New Jersey Department of Health. Three models were used to estimate the RN shortage for each hospital, which was the difference between the demand and supply of RN full-time equivalents. Results Data were available on 66 New Jersey hospitals, more than half of which experienced a shortage of RNs during Hurricane Sandy. For hospitals with a RN shortage in ICUs, a 20% increase in observed RN supply was needed to meet the demand; and a 10% increase in observed RN supply was necessary to meet the demand for hospitals with a RN shortage in non-ICUs. Conclusion Findings from this study suggest that many hospitals in New Jersey had a shortage of RNs during Hurricane Sandy. Efforts are needed to improve the availability of nurse resources during a natural disaster.

Incidence and Risk Factors of In-hospital Prosthesis-Related Complications Following Total Shoulder Arthroplasty

BackgroundThe occurrence of prosthesis-related complications after total shoulder arthroplasty is devastating and costly. The purpose was to determine the incidence and risk of in-hospital prosthesis-related complications after total shoulder arthroplasty utilizing a large-scale sample database.MethodsA retrospective database analysis was performed based on Nationwide Inpatient Sample from 2010 to 2014. Patients who underwent total shoulder arthroplasty were included. Patient demographics, hospital characteristics, length of stay, economic indicators, in-hospital mortality, comorbidities, and peri-operative complications were evaluated.ResultsA total of 34,198 cases were capture from the Nationwide Inpatient Sample database. There were 343 cases of in-hospital prosthesis-related complications after total shoulder arthroplasty and the overall incidence was 1%, with a more than 2.5-fold decrease from 2010 to 2014. Dislocation was the most common category among prosthesis-related complications (0.1%). The occurrence of in-hospital prosthesis-related complications was associated with significantly more total charges and slightly longer length of stay while less usage of Medicare. Risk factors of prosthesis-related complications were identified including younger age (<64 years), female, the native American, hospital in the South, alcohol abuse, depression, uncomplicated diabetes, diabetes with chronic complications, fluid and electrolyte disorders, metastatic cancer, neurological disorders, and renal failure. Interestingly, advanced age (≥65 years) and proprietary hospital were found as protective factors. Furthermore, prosthesis-related complications were associated with aseptic necrosis, rheumatoid arthritis, rotator cuff tear arthropathy, Parkinson’s disease, prior shoulder arthroscopy, and blood transfusion.ConclusionsIt is of benefit to study risk factors of prosthesis-related complications following total shoulder arthroplasty to ensure the appropriate management and optimize consequences although a relatively low incidence was identified.

The Use of Intermittent Non-Invasive Ventilation as an Alveolar Recruitment Method for Patient with Severe COVID 19 Pneumonia

Background: The use of non-invasive ventilation (NIV) as a therapy for acute respiratory distress syndrome (ARDS) secondary to COVID 19 pneumonia has been controversial. NIV is an aerosol generating procedure which may increase the risk of viral transmission amongst patients and staff. Because of fear of aerosolizing the virus and transmitting the disease, initial expert recommendation was to avoid NIV and proceed with early intubation. With further experience of the virus, this recommendation has been challenged and NIV has been used widely with some retrospective studies quoting between 11 to 56 percent of COVID 19 related respiratory failures being treated with NIV. Objective: The objective of this study is to assess the efficacy and safety of using non-invasive mechanical ventilation as an alveolar recruitment method for patients with severe COVID 19 pneumonia. This method was used by our respiratory team on selected patients during the early phase of the COVID 19 pandemic. Methods: We reviewed the charts of patients that were admitted to the American Hospital Dubai intensive care unit, or our medical step-down unit who had diffuse bilateral infiltrates requiring oxygen supplementation between March and October 2020. We identified patients who were on intermittent BiPAP in addition to standard care. We also monitored the rate of infection among staff taking care of these patients. Results: Average length of stay after starting BIPAP therapy was 6.8 days, while the average total length of stay was 13.6 days. Only one patient was transferred to the ICU after being on the BIPAP protocol and did not need intubation. All patients were discharged home either without oxygen or with their chronic baseline home oxygen requirement. Radiological improvement in aeration was seen in 100% of patients at follow-up x-ray post-intervention. There were no reported pulmonary complications from barotrauma, such as pneumothorax or pneumomediastinum. There were no reported cases of staff infection to the health care workers that were taking care of these patients Conclusion: Our first of its kind observational study showed clearly that using BIPAP therapy for one hour three times daily during nebulization therapy in addition to standard care resulted in a significant reduction in hospital length of stay and hastened the clinical and radiological improvement of patients with severe COVID 19 pneumonia.

Association of women leaders in the C-suite with hospital performance

BackgroundWomen comprise 50% of the healthcare workforce, but only about 25% of senior leadership positions in the USA. No studies to our knowledge have investigated the performance of hospitals led by women versus those led by men to evaluate the potential explanation that the inequity reflects appropriate selection due to skill or performance differences.MethodsWe conducted a descriptive analysis of the gender composition of hospital senior leadership (C-suite) teams and cross-sectional, regression-based analyses of the relationship between gender composition, hospital characteristics (eg, location, size, ownership), and financial, clinical, safety, patient experience and innovation performance metrics using 2018 data for US adult medical/surgical hospitals with >200 beds. C-suite positions examined included chief executive officer (CEO), chief financial officer (CFO) and chief operating officer (COO). Gender was obtained from hospital web pages and LinkedIn. Hospital characteristics and performance were obtained from American Hospital Directory, American Hospital Association Annual Hospital Survey, Healthcare Cost Report Information System and Hospital Consumer Assessment of Healthcare Providers and Systems surveys.ResultsOf the 526 hospitals studied, 22% had a woman CEO, 26% a woman CFO and 36% a woman COO. While 55% had at least one woman in the C-suite, only 15.6% had more than one. Of the 1362 individuals who held one of the three C-suite positions, 378 were women (27%). Hospital performance on 27 of 28 measures (p>0.05) was similar between women and men-led hospitals. Hospitals with a woman CEO performed significantly better than men-led hospitals on one financial metric, days in accounts receivable (p=0.04).ConclusionHospitals with women in the C-suite have comparable performance to those without, yet inequity in the gender distribution of leaders remains. Barriers to women’s advancement should be recognised and efforts made to rectify this inequity, rather than underusing an equally skilled pool of potential women leaders.

Analysis of the Early Clinical Effect of Simultaneous Ipsilateral Total Hip and Knee Arthroplasty in the Treatment of End-stage Hemophilic Arthritis

ObjectiveTo evaluate the clinical efficacy of simultaneous ipsilateral total hip arthroplasty (THA) and total knee arthroplasty (TKA) in the treatment of advanced hemophilic arthritis. Methodthe clinical data of 8 patients with advanced hemophilic arthritis, with ages of 31.6±6.2 years (ranging from 25-38 years, who underwent ipsilateral THA and TKA at the ** Hospital from January 2018 to May 2021 were retrospectively analyzed. There were 6 cases of hemophilia A and 2 cases of hemophilia B. The preoperative level of coagulation factor VIII was 1.8(±1.3)%，activated partial prothrombin time (aPTT) was 131.2 (±35.3) s. A comparison of the Harris score before and 0.3-1 year after operation was performed to evaluate hip function, American hospital for special surgery (HSS) knee score and American Knee society score (KSS) score. ResultDuring the follow-up period of 1.4 (± 1.1) years, no intra-articular bleeding and skin dehiscence were found in the early postoperative period, and no joint infection, bleeding, prosthesis loosening and sinking were found in the last follow-up visit. The Harris score increased from 16.8 (± 4.4) preoperatively to 77.6 (± 7.1) postoperatively, HSS knee score increased from 41.8 (± 4.2) preoperatively to 76.0 (± 5.8) postoperatively, the clinical KSS increased from 35.6 (± 10.8) preoperatively to 79.2 (± 6.9) postoperatively. The KSS increased from 22.8 (± 8.4) preoperatively to 72.0 (± 5.9) postoperatively at the last follow-up visit. The differences were statistically significant (P < 0.05).ConclusionsIpsilateral THA and TKA in the treatment of advanced hemophilic arthritis can effectively relieve pain, and improve hip and knee joint function, as well as the quality of life, and can thus be recommended as a safe and effective measure for the treatment of advanced hemophilic arthritis.

Engaging Isolated and Underserved Older Adults in 4Ms Care: Age-Friendly Care, PA

Older adults, the largest segment of the US rural population, face significant disparities in health and healthcare compared to their non-rural peers, including more chronic health conditions, financial challenges, and social isolation. They have limited access to healthcare and social services for prevention, management and treatment of chronic conditions. Age-Friendly Care-PA, a partnership between Primary Health Network and Penn State College of Nursing, aims to reduce these disparities in care and services for rural older adults through co-designing their Geriatric Workforce Enhancement Program. Age-Friendly Health Systems, an initiative of the John A Hartford Foundation and the Institute for Healthcare Improvement, in partnership with the American Hospital Association and the Catholic Health Association of the United States, equips providers, older adults, and their care partners with the support necessary to address What Matters, Medication, Mentation, and Mobility. This symposium describes how the 4Ms are integrated into clinician training and competencies, older adult education, operations, care delivery, and quality improvement. Year two outcome data will be shared. Drs. Hupcey and Fick will provide an overview of the project and its reach. Dr. Berish will describe the process of engaging stakeholders in co-developing our 4M metrics and the data generated. Jenny Knecht, CRNP, will describe a pilot study to extend the reach and acceptability of telehealth to hard-to-reach older persons. Finally, Dr. Garrow will detail a new initiative focused on equity in care. Our discussant, Dr. Terry Fulmer will lead a discussion of this work as well as next steps and policy implications.

For-profit hospitals as anchor institutions in the United States: a study of organizational stability

Background Anchor institutions, by definition, have a long-term presence within their local communities, but it is uncertain as to whether for-profit hospitals meet this definition; most research on anchor institutions to date has been limited to nonprofit organizations such as hospitals and universities. Accordingly, this study aims to determine whether for-profit hospitals are stable enough to fulfill the role of anchor institutions through a long-term presence in communities which may help to stabilize local economies. Methods This longitudinal study analyzes national, secondary data between 2008 and 2017 compiled from the Dartmouth Atlas of Health Care, the American Hospital Association Annual Survey, and County Health Rankings. We use descriptive statistics to calculate the number of closures and mergers of hospitals of different ownership type, as well as staffing levels. Using logistic regression, we also assessed whether for-profit hospitals had higher odds of closing and merging, controlling for both organization and community factors. Results We found for-profit hospitals to be less stable than their public and nonprofit hospital counterparts, experiencing disproportionately more closures and mergers over time, with a multivariable analysis indicating a statistically significant difference. Furthermore, for-profit hospitals have fewer full-time employees relative to their size than hospitals of other ownership types, as well as lower total payroll expenditures. Conclusions Study findings suggest that for-profit hospitals operate more efficiently in terms of expenses, but this also may translate into a lower level of economic contributions to the surrounding community through employment and purchasing initiatives. For-profit hospitals may also not have the stability required to serve as long-standing anchor institutions. Future studies should consider whether for-profit hospitals make other types of community investments to offset these deficits and whether policy changes can be employed to encourage anchor activities from local businesses such as hospitals.