Melissa De Regge

Excessive chest compression rate is associated with insufficient compression depth in prehospital cardiac arrest

UNLABELLED BACKGROUND AND GOAL OF STUDY: The relationship between chest compression rate and compression depth is unknown. In order to characterise this relationship, we performed an observational study in prehospital cardiac arrest patients. We hypothesised that faster compressions are associated with decreased depth. MATERIALS AND METHODS In patients undergoing prehospital cardiopulmonary resuscitation by health care professionals, chest compression rate and depth were recorded using an accelerometer (E-series monitor-defibrillator, Zoll, U.S.A.). Compression depth was compared for rates <80/min, 80-120/min and >120/min. A difference in compression depth ≥0.5 cm was considered clinically significant. Mixed models with repeated measurements of chest compression depth and rate (level 1) nested within patients (level 2) were used with compression rate as a continuous and as a categorical predictor of depth. Results are reported as means and standard error (SE). RESULTS AND DISCUSSION One hundred and thirty-three consecutive patients were analysed (213,409 compressions). Of all compressions 2% were <80/min, 62% between 80 and 120/min and 36% >120/min, 36% were <4 cm deep, 45% between 4 and 5 cm, 19% >5 cm. In 77 out of 133 (58%) patients a statistically significant lower depth was observed for rates >120/min compared to rates 80-120/min, in 40 out of 133 (30%) this difference was also clinically significant. The mixed models predicted that the deepest compression (4.5 cm) occurred at a rate of 86/min, with progressively lower compression depths at higher rates. Rates >145/min would result in a depth <4 cm. Predicted compression depth for rates 80-120/min was on average 4.5 cm (SE 0.06) compared to 4.1 cm (SE 0.06) for compressions >120/min (mean difference 0.4 cm, P<0.001). Age and sex of the patient had no additional effect on depth. CONCLUSIONS This study showed an association between higher compression rates and lower compression depths. Avoiding excessive compression rates may lead to more compressions of sufficient depth.

Basic life support refresher training of nurses: Individual training and group training are equally effective

BACKGROUND AND OBJECTIVES Basic life support (BLS) skills of hospital nurses are often poor. We compared individual BLS refresher training (IT; one instructor to one trainee) with group refresher training (GT; one instructor to six trainees). We hypothesised that IT would result in better skill acquisition and retention. METHODS Nurses from non-critical care wards (n=120) were randomised to IT or GT. Skills were assessed by a 3 min BLS test on a computerised manikin (Laerdal, Norway) immediately before training (T0), immediately after training (T1), and 10 months after training (T2). Results are expressed as median and [interquartile range]. RESULTS The study was completed by 103 nurses (IT 56, GT 47). For GT the median group size was 5 [4-5]. The median duration of IT was 20 [17-21] min. The median duration of GT was 90 [84-95] or 19 min per trainee. Baseline skills did not differ between GT and IT, except for less compressions with correct depth for IT. At T1 and T2 there were no clinically significant differences between GT and IT for number of ventilations, ventilation volume, number of compressions, compression depth, compression rate and hands off time. Total instructor time was similar for IT and GT training strategies. CONCLUSIONS There was no difference in IT and GT immediately and 10 months after training. However, training time per nurse for IT was only one fifth, whereas total instructor time did not increase. Although not superior in outcome, IT may be a cost-effective alternative for GT.

Effects of physician-owned specialized facilities in health care: A systematic review

BACKGROUND Multiple studies have investigated physician-owned specialized facilities (specialized hospitals and ambulatory surgery centres). However, the evidence is fragmented and the literature lacks cohesion. OBJECTIVES To provide a comprehensive overview of the effects of physician-owned specialized facilities by synthesizing the findings of published empirical studies. METHODS Two reviewers independently researched relevant studies using a standardized search strategy. The Institute of Medicines quality framework (safe, effective, equitable, efficient, patient-centred, and accessible care) was applied in order to evaluate the performance of such facilities. In addition, the impact on the performance of full-service general hospitals was assessed. RESULTS Forty-six studies were included in the systematic review. Overall, the quality of the included studies was satisfactory. Our results show that little evidence exists to confirm the advantages attributed to physician-owned specialized facilities, and their impact on full-service general hospitals remains limited. CONCLUSION Although data is available on a wide variety of effects, the evidence base is surprisingly thin. There is no compelling evidence available demonstrating the added value of physician-owned specialized facilities in terms of quality or cost of the delivered care. More research is necessary on the relative merits of physician-owned specialized facilities. In addition, their corresponding impact on full-service general hospitals remains unclear. The development of physician-owned specialized facilities should thus be monitored carefully.

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.

Service quality and patient experiences of ambulatory care in a specialized clinic vs. a general hospital

Objectives: Health care organizations are constantly looking for ways to establish a differential advantage to attract customers. To this end, service quality has become an important differentiator in the strategy of health care organizations. In this study, we compared the service quality and patient experience in an ambulatory care setting of a physician-owned specialized facility with that of a general hospital. Method: A comparative case study with a mixed method design was employed. Data were gathered through a survey on health service quality and patient experience, completed with observations, walkthroughs, and photographic material. Results: Service quality and patient experiences are high in both the investigated health care facilities. A significant distinction can be made between the two facilities in terms of interpersonal quality (p = 0.001) and environmental quality (P ≤ 0.001), in favor of the medical center. The difference in environmental quality is also indicated by the scores given by participants who had been in both facilities. Qualitative analysis showed higher administrative quality in the medical center. Environmental quality and patient experience can predict the interpersonal quality; for environmental quality, interpersonal quality and age are significant predictors. Conclusions: Service quality and patient experiences are high in both facilities. The medical center has higher service quality for interpersonal and environmental service quality and is more process-centered.

A multilevel analysis of factors influencing the flow efficiency of the cataract surgery process in hospitals.

To detect factors contributing to variation in cataract surgery processes.

Training Nurses in a Self-Learning Station for Resuscitation: Factors Contributing to Success or Failure

Many studies report poor CPR performance by health care professionals during training programs and real-life CPR. A critical determinant of the effectiveness of training is corrective feedback. During traditional training and retraining sessions, feedback is usually provided by an instructor. Three potentially important shortcomings of these instructor-led courses are the instructors’ competence, high labor costs, and organizational problems. CPR training and retraining in a computerized self-learning (SL) station may overcome some of the limitations of instructor-led courses. The Resusci Anne Skills Station (Laerdal, Norway) is currently the only commercially available computerized CPR SL system using corrective voice feedback technology. Previous studies have shown that CPR skills can be improved with use of this Resusci Anne Skills Station. Our research group reported non-inferiority for teaching compression depth between instructor-led training and training in the SL station. During these studies, we observed differences between nurses with regard to the ability to complete the SL training successfully. The aims of the present study were to analyze the training process of nurses in an SL station and identify factors associated with strong and weak performance.

Hospital networks: how to make them work in Belgium? Facilitators and barriers of different governance models

Abstract Objectives This study aims to identify the facilitators and barriers to governance models of hospital collaborations. The country-specific characteristics of the Belgian healthcare system and legislation are taken into account. Methods A case study was carried out in six Belgian hospital collaborations. Different types of governance models were selected: two health systems, two participant-governed networks, and two lead-organization-governed networks. Within these collaborations, 43 people were interviewed. Results All structures have both advantages and disadvantages. It is important that the governance model fits the network. However, structural, procedural, and especially contextual factors also affect the collaborations, such as alignment of hospitals’ and professionals’ goals, competition, distance, level of integrated care, time needed for decision-making, and legal and financial incentives. Conclusion The fit between the governance model and the collaboration can facilitate the functioning of a collaboration. The main barriers we identified are contextual factors. The Belgian government needs to play a major role in facilitating collaboration.

Analysis of failed discharge after ambulatory surgery : unanticipated admission

Abstract Background: Advantages of ambulatory surgery are lost when patients need an unplanned admission. This retrospective cohort study investigated reasons for failed discharge and unanticipated admission of adult patients after day surgery. Methods: Ambulatory patients (n = 145) requiring unanticipated admission were compared to patients (n = 4980) not requiring admission and timely discharged from a total of 5156 ambulatory surgical procedures. Demographic data, organisational data, reason for admission, type of anesthesia, surgical discipline, length of procedure, ASA classification, surgical completion time and severity of illness score were collected from both groups. Reason for admission was classified according to four subtypes. Logistic regression analysis was used. Results: Incidence of unanticipated admission following day care surgery was 2.89%. The reasons for admission were mainly organisational issues (45.52%), time of completion surgery in the afternoon between 12 pm and 3 pm (OR 1.73; 95% CI 1.05–2.86) and surgery that ends after 3 pm (OR 6.52; 95% CI 4.11–10.34). Surgical factors associated with unanticipated admission (38.62%) were length of surgery of one to three hours (OR 2.05; 95% CI 1.27–3.29), length of surgery more than three hours (OR 8.31; 95% CI 3.56–19.40). Additionally, anaesthetic (10.34%) and medical (5.52%) reasons were found, e.g. ASA class II (OR 1.61; 95% CI 1.06–2.44), ASA class III (OR 2.19; 95% CI 1.10–4.34); moderate severity of illness score (OR 1.72; 95% CI 1.03–2.88) and major of severity of illness score (OR 7.85; 95% CI 2.31–26.62). Conclusions: Unanticipated admissions following day surgery occur mainly due to social/organisational and surgical reasons. However, medical and anaesthetic reasons also explain 15.86% of the unanticipated admissions.

Improving care processes through optimized design of the operating system

The impact of the design of the operating system on operational performance is seldom discussed in health care. We conducted a comparative mixed-method case analysis of sequential-care processes in hospitals. We examined differences in the organization of sequential care processes, whether sequential care processes with fully compatible operating systems perform better than those not fully compatible with the operating system, and the causes of variation in sequential care processes. Our findings suggest that, overall, hospitals design their operating system for low turnover times and smooth transitions. They show that aligning structure and processes components with the operational system positively influences operational performance. However, we note that not all cases make optimal use of this concept. Besides special-cause variation disrupting flow efficiency, the results demonstrate that other variables that can be taken into account in planning care processes influence the process. Above that, this p...