Kristof Eeckloo

Strained Local And State Government Finances Among Current Realities That Threaten Public Hospitals’ Profitability

This study demonstrates that some safety-net hospitals--those that provide a large share of the care to low-income, uninsured, and Medicaid populations--survived and even thrived before the recent recession. We analyzed the financial performance and governance of 150 hospitals during 2003-07. We found, counterintuitively, that those directly governed by elected officials and in highly competitive markets were more profitable than other safety-net hospitals. They were financially healthy primarily because they obtained subsidies from state and local governments, such as property tax transfers or supplemental Medicaid payments, including disproportionate share payments. However, safety-net hospitals now face a new market reality. The economic downturn, slow recovery, and politics of deficit reduction have eroded the ability of local governments to support the safety net. Many safety-net hospitals have not focused on effective management, cost control, quality improvement, or services that attract insured patients. As a result, and coupled with new uncertainties regarding Medicaid expansion stemming from the recent Supreme Court decision on the Affordable Care Act, many are likely to face increasing financial and competitive pressures that may threaten their survival.

Compliance with a structured bedside handover protocol: An observational, multicentred study

BACKGROUND Bedside handover is the delivery of the nurse-to-nurse shift handover at the patients bedside. The method is increasingly used in nursing, but the evidence concerning the implementation process and compliance to the method is limited. OBJECTIVES To determine the compliance with a structured bedside handover protocol following ISBARR and if there were differences in compliance between wards. DESIGN A multicentred observational study with unannounced and non-participatory observations (n = 638) one month after the implementation of a structured bedside handover protocol. SETTINGS AND PARTICIPANTS Observations of individual patient handovers between nurses from the morning shift and the afternoon shift in 12 nursing wards in seven hospitals in Flanders, Belgium. METHODS A tailored and structured bedside handover protocol following ISBARR was developed, and nurses were trained accordingly. One month after implementation, a minimum of 50 observations were performed with a checklist, in each participating ward. To enhance reliability, 20% of the observations were conducted by two researchers, and inter-rater agreement was calculated. Data were analysed using descriptive statistics, one-way ANOVAs and multilevel analysis. RESULTS Average compliance rates to the structured content protocol during bedside handovers were high (83.63%; SD 11.44%), and length of stay, the type of ward and the nursing care model were influencing contextual factors. Items that were most often omitted included identification of the patient (46.27%), the introduction of nurses (36.51%), hand hygiene (35.89%), actively involving the patient (34.44%), and using the call light (21.37%). Items concerning the exchange of clinical information (e.g., test results, reason for admittance, diagnoses) were omitted less (8.09%-1.45%). Absence of the patients (27.29%) and staffing issues (26.70%) accounted for more than half of the non-executed bedside handovers. On average, a bedside handover took 146 s per patient. CONCLUSIONS When the bedside handover was delivered, compliance to the structured content was high, indicating that the execution of a bedside handover is a feasible step for nurses. The compliance rate was influenced by the patients length of stay, the nursing care model and the type of ward, but their influence was limited. Future implementation projects on bedside handover should focus sufficiently on standard hospital procedures and patient involvement. According to the nurses, there was however a high number of situations where bedside handovers could not be delivered, perhaps indicating a reluctance in practice to use bedside handovers.

Patient and public involvement in hospital policy-making: Identifying key elements for effective participation

The involvement of patients and the public in healthcare decisions becomes increasingly important. Although patient involvement on the level of the individual patient-healthcare worker relationship is well studied, insight in the process of patient and public involvement on a more strategic level is limited. This study examines the involvement of patient and public (PPI) in decision-making concerning policy in six Flemish hospitals. The hospitals organized a stakeholder committee which advised the hospital on strategic policy planning. A three-phased mixed- methods study design with individual questionnaires (n = 69), observations (n = 10) and focus groups (n = 4) was used to analyze, summarize and integrate the findings. The results of this study indicate that: (1) PPI on hospital level should include the possibility to choose topics, like operational issues; (2) PPI-stakeholders should be able to have proper preparation; (3) PPI-stakeholders should be externally supported by a patient organization; (4) more autonomy should be provided for the stakeholder committee. Additionally, the study indicates that the influence of national legislation on stakeholder initiatives in different countries is limited. In combination with the growing importance of PPI and the fact that the recommendations presented are not claimed to be exhaustive, more transnational and conceptual research is needed in the future.

The role of hospitals in bridging the care continuum : A systematic review of coordination of care and follow-up for adults with chronic conditions

BackgroundMultiple studies have investigated the outcome of integrated care programs for chronically ill patients. However, few studies have addressed the specific role hospitals can play in the downstream collaboration for chronic disease management. Our objective here is to provide a comprehensive overview of the role of the hospitals by synthesizing the advantages and disadvantages of hospital interference in the chronic discourse for chronically ill patients found in published empirical studies.MethodSystematic literature review. Two reviewers independently investigated relevant studies using a standardized search strategy.ResultsThirty-two articles were included in the systematic review. Overall, the quality of the included studies is high. Four important themes were identified: the impact of transitional care interventions initiated from the hospital’s side, the role of specialized care settings, the comparison of inpatient and outpatient care, and the effect of chronic care coordination on the experience of patients.ConclusionOur results show that hospitals can play an important role in transitional care interventions and the coordination of chronic care with better outcomes for the patients by taking a leading role in integrated care programs. Above that, the patient experiences are positively influenced by the coordinating role of a specialist. Specialized care settings, as components of the hospital, facilitate the coordination of the care processes. In the future, specialized care centers and primary care could play a more extensive role in care for chronic patients by collaborating.

The Development and Validation of the Patient Participation Culture Tool for Inpatient Psychiatric Wards (PaCT-PSY)

ABSTRACT Patient participation is an important topic in mental health and receives increased attention along with deinstitutionalization. No tool exists to measure healthcare worker‐related factors that influence patient participation. A three‐staged study was conducted to develop and validate the ‘Patient Participation Culture Tool for inpatient PSYchiatric wards’ (PaCT‐PSY), and to analyse its psychometric properties (n = 603). The 60‐items tool, comprising thirteen components, showed content validity, strong psychometric properties, and a high internal consistency. The PaCT‐PSY measures the patient participation culture on psychiatric wards by exploring healthcare workers factors influencing patient participation. It enables researchers, practitioners and administrators to develop tailored actions.

Is pain at discharge a risk factor for unplanned hospital readmission

Introduction: Unplanned readmissions are associated with a high cost to health insurances and the incidence of preventable readmissions could be considered as a quality indicator for the initial hospital admission. We aimed to assess the predictive value for unplanned readmission of higher pain scores at discharge of the initial admission as well as of other pain and demographic characteristics. The documentation of significant associations would provide further support for a structured pain management policy. Methods: A retrospective analysis of a large single university hospital data-set of 33.122 admissions within a 13-month period allowed for the assessment of the predictive relationship of pain toward unplanned readmission at 7 and at 30 days after discharge through logistic regression, and of other characteristics through linear regression. Results: Pain scores at discharge of the initial admission were not significantly different (p > 0.05) with or without unplanned readmission and hence have no predictive value on the individual patient level. The prediction of the number of patients for each group, for example the number of patients that will be readmitted (size of the group), shows significance for pain at the moment of discharge (p_initial = 0.000), pain medication (p = 0.0044), and age (p = 0.0017). Pathology (p = 0.6151) and gender (p = 0.7029) have no significant predictive value. Conclusion: Pain as dichotomous variable upon discharge cannot be used as single risk predictor for unplanned readmission. However, the pain score at discharge in combination with the use of pain medication and age is a risk factor for the number of short-term unplanned readmissions.

The influence of healthcare worker-related determinants on a ward's patient participation culture

Background: Cancer is considered as chronic condition, especially in the older people. Prevalence of cancer is especially high in the Nordic countries and Mediterranean countries. People with cance ...Background: To measure the attitudes towards older people and perceptions of working with older people of undergraduate health and social care students in 5 European countries. Questionnaires are one of the most widely used data collection methods. The use of questionnaires constructed and validated in a setting to other setting is an essential aspect in international studies, which have as main objective to compare and deduce similarities and differences within different contexts. There are three main aspects in validation, the linguistic, the cultural and statistic validation,all these three aspects are essential during theprocess. Materials: Two questionnaires were used: Attitudes towards Older People Scale (Kogan1966) and Students’ Perception of Working with Older People Scale (Nolan et al, 2006). Methods: Five Countries were involved in the study namely Ireland, Finland, Germany, Latvia, and Italy. Back translation methodology was used in order to translate questionnaire (Linguistic and cultural validation) while a Cronbach was calculate to assess internal validity (statistic validation). Results: Students (n = 955) completed the two questionnaires. Students’ Perception of Working with Older People Scale, shows a 0.81 a Cronbach for all sample, for Ireland 0.84, Germany, 0.79, Italy 0.79, Finland 0.84 and Latvia 0.59, Attitudes towards Older People Scale shows a 0.83 a Cronbach for all sample,for Ireland 0.85, Germany, 0.83, Italy 0.62, Finland 0.86 and Latvia 0.74. Respondents were generally positive towards older people with few differences between countries. Those with least experience with older people displayed more negative attitudes. Significant relationships were found between positive 50

Adherence to guidelines for the management of donors after brain death

Purpose: Guideline adherence for the management of a donor after brain death (DBD) is largely unknown. This study aimed to perform an importance‐performance analysis of prioritized key interventions (KIs) by linking guideline adherence rates to expert consensus ratings for the management of a DBD. Materials and methods: This observational, cross‐sectional multicenter study was performed in 21 Belgian ICUs. A retrospective review of patient records of adult utilized DBDs between 2013 and 2016 used 67 KIs to describe adherence to guidelines. Results: A total of 296 patients were included. Thirty‐five of 67 KIs had a high level of adherence congruent to a high expert panel rating of importance. Nineteen of 67 KIs had a low level of adherence in spite of a high level of importance according to expert consensus. However, inadequate documentation proved an important issue, hampering true guideline adherence assessment. Adherence ranged between 3 and 100% for single KI items and on average, patients received 72% of the integrated expert panel recommended care set. Conclusions: Guideline adherence to an expert panel predefined care set in DBD donor management proved moderate leaving substantial room for improvement. An importance‐performance analysis can be used to improve implementation and documentation of guidelines.

Is privacy a problem during bedside handovers? A practice-oriented discussion paper

Bedside handover is the delivery of the nurse-to-nurse handover at the patient’s bedside. Although increasingly used in nursing, nurses report many barriers for delivering the bedside handover. Among these barriers is the possibility of breaching the patient’s privacy. By referring to this concept, nurses add a legal and ethical dimension to the delivery of the bedside handover, making implementation of the method difficult or even impossible. In this discussion article, the concept of privacy during handovers is being discussed by use of observations, interviews with nurses, and interviews with patients. These findings are combined with international literature from a narrative review on the topic. We provide a practice-oriented answer in which two mutually exclusive possibilities are discussed. If bedside handover does pose problems concerning privacy, this situation is not unique in healthcare and measures can be taken during the bedside handover to safeguard the patient. If bedside handover does not pose problems concerning privacy, privacy is misused by nurses to hide professional uncertainties and/or a reluctance toward patient participation. Therefore, a possible breach of privacy—whether a justified argument or not—is not a reason for not delivering the bedside handover.

Organizing Health Care Networks: Balancing Markets, Government and Civil Society

Much is changing in health care organization today. A perspective or paradigm that is gaining ever increasing momentum is that of translational, extramural and integrated care. Current research suggests many potential benefits for integrated care and health care networks but the ethical issues are less frequently emphasized. Showing that integrated care can be beneficial, does not mean it is automatically ethically justified. We will argue for three ethical requirements such health care networks should meet. Subsequently we will look at the mechanisms driving the formation of networks and examine how these can cause networks to meet or fail to meet these ethical requirements or obligations. The three mechanisms we will examine are government, civil society and market mechanisms, which, we argue, should be balanced properly. Each mechanism is able to provide a relevant ethical perspective to health care networks. However, when the balance is skewed towards a single mechanism, health care networks might fail to promote one or more of the ethical requirements.