Investing in Skilled Specialists to Grow Hospital Infrastructure for Quality Improvement
| Autor: | William V. Padula, Patricia M. Davidson, Peter J. Pronovost, Madhuram Nagarajan |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Male
Quality management Leadership and Management media_common.quotation_subject Specialty pressure injury 03 medical and health sciences Patient safety The Health Care Manager 0302 clinical medicine Health care medicine Humans Quality (business) 030212 general & internal medicine media_common Retrospective Studies health system infrastructure business.industry 030503 health policy & services Public Health Environmental and Occupational Health Retrospective cohort study medicine.disease Quality Improvement Hospitals workforce supply Cohort Observational study Female Medical emergency 0305 other medical science business performance Specialization |
| Zdroj: | Journal of Patient Safety |
| ISSN: | 1549-8425 |
| Popis: | Objectives Hospitals can reduce labor costs by hiring lowest skill possible for the job, stretching clinical hours, and reducing staff not at bedside. However, these labor constraints designed to reduce costs may paradoxically increase costs. Specialty staff, such as board-certified clinicians, can redesign health systems to evaluate the needs of complex patients and prevent complications. The aim of the study was to evaluate whether investing in skilled specialists for supporting hospital quality infrastructure improves value and performance. Methods We evaluated pressure injury rates as an indicator of performance in a retrospective observational cohort of 55 U.S. academic hospitals from the Vizient clinical database between 2007 and 2012. Pressure injuries were defined by U.S. Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicator 3 (PSI-03) for stage 3, 4, and unstageable pressure injuries not present on admission in hospitalized adults. We compared ratios of board-certified wound care nurses per 1000 hospital beds to hospital-acquired pressure injury rates in these hospitals using mixed-effects regression of hospital quarters. Results High-performing hospitals invested in prevention infrastructure with skilled specialists and observed performance improvements. Regression indicated that by adding one board-certified wound care nurse per 1000 hospital beds, hospitals had associated decreases in pressure injury rates by -17.7% relative to previous quarters, controlling for other interruptions. Highest performers supplied fewer skilled specialists and achieve improved outcomes. Conclusions Skilled specialists bring important value to health systems as a representation of investment in infrastructure, and the proportion of these specialists could be scaled relative to the hospital's patient capacity. Policy should support hospitals to make investments in infrastructure to drive down patient costs and improve quality. |
| Databáze: | OpenAIRE |
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