The Cost of Negative Perceptions of the Work Environment Among Intermediate Intensive Care Unit Nurses

This descriptive study assessed the perceptions of the work environment and the retention plans among registered nurses (RNs) who worked in the Intermediate Intensive Care Unit at a tertiary university hospital. Results from the Moos Work Environment Scale found that nurses perceived high levels of work pressure and low levels of clarity, coworker cohesion, and supervisor support. Results indicated that the intent to leave the unit was dependent on the nurses having other options in nursing, desiring further education, an undesirable scheduling process and unsafe patient care. The direct and indirect costs to hospitals could be offset by developing strategies to enhance the work environment, therefore increasing RN retention

Hospital Car Parking: The Impact of Access Costs

NHS Trusts have statutory powers to raise income, which allow them to decide whether to charge, and how much to charge, for hospital car parking. Trusts are not obliged to provide parking facilities on their premises, but provision will inevitably incur costs in the form of maintenance, security and staffing. If Trusts choose not to charge for parking, then these costs must be covered from other sources of revenue, potentially diverting resources from patient care. Charges typically account for around 0.25% of a hospital?s income, but can be as high as 1%. The government offers financial support to people on low incomes who incur travel expenses when accessing health care.

Core components for effective infection prevention and control programmes: new WHO evidence-based recommendations

Abstract Health care-associated infections (HAI) are a major public health problem with a significant impact on morbidity, mortality and quality of life. They represent also an important economic burden to health systems worldwide. However, a large proportion of HAI are preventable through effective infection prevention and control (IPC) measures. Improvements in IPC at the national and facility level are critical for the successful containment of antimicrobial resistance and the prevention of HAI, including outbreaks of highly transmissible diseases through high quality care within the context of universal health coverage. Given the limited availability of IPC evidence-based guidance and standards, the World Health Organization (WHO) decided to prioritize the development of global recommendations on the core components of effective IPC programmes both at the national and acute health care facility level, based on systematic literature reviews and expert consensus. The aim of the guideline development process was to identify the evidence and evaluate its quality, consider patient values and preferences, resource implications, and the feasibility and acceptability of the recommendations. As a result, 11 recommendations and three good practice statements are presented here, including a summary of the supporting evidence, and form the substance of a new WHO IPC guideline

Healthcare-associated bloodstream infections in a neonatal intensive care unit over a 20-year period (1992-2011) : trends in incidence, pathogens, and mortality

Objective. To analyze trends in the incidence and pathogen distribution of healthcare-associated bloodstream infections (HABSIs) over a 20-year period (1992-2011). Design. Historical cohort study. Setting. Thirty-two-bed neonatal intensive care unit (NICU) in a tertiary referral hospital. Patients. Neonates with HABSIs defined according to the criteria of the National Institute of Child Health and Development (NICHD). Methods. A hospital-based ongoing surveillance program was used to identify HABSI cases in neonates. A distinction between definite or possible HABSI was made according to the NICHD criteria. Incidence, incidence densities (HABSIs per 1,000 hospital-days and HABSIs per 1,000 total parenteral nutrition-days), and case fatality rate were calculated. Logistic regression analysis was used to find time trends. Four periods of 5 years were considered when executing variance analysis. Results. In total, 682 episodes of HABSIs occurred on 9,934 admissions (6.9%). The median total incidence density rate was 3.1 (interquartile range, 2.2-3.9). A significant increasing time trend in incidence density was observed for the period 1995-2011 (P < .003). A significant decrease in the case fatality rate was found in the last 5-year period (P < .001). No neonate died following possible HABSIs, whereas the case fatality rate among neonates with definite HABSIs was 9.7%. Most HABSIs were caused by coagulase-negative staphylococci (n = 414 [60.7%]). A significant increase in Staphylococcus aureus HABSI was observed in the last 10-year period (P < .001). Conclusions. An increase in incidence density rate occurred, while the case fatality rate dropped. Better perinatal care could be responsible for the latter. A decrease in days before infection and a high incidence of coagulase-negative Staphylococcus HABSIs indicate the need for vigorous application of evidence-based prevention initiatives, in particular for catheter care

The current crisis of intensive work regimes and the question of social exclusion in industrialized countries

The aim of this article is to analyze the difficulties currently being faced by regimes of social regulation of economic life and the ways in which they are being transformed. In order to address this complex question, transformations in the labour market are examined. Emphasis is given in particular to the fact that the decline in life-time jobs has had a destabilizing impact on employment systems. This is true not so much in terms of reduced employment. In fact, numerous job opportunities have been created in the tertiary sector, though insecure and badly paid, but these jobs do not reflect the traditional standards of social regulation and therefore entail a weakening of the mechanisms of social integration and a growing risk of exclusion. At this point the theme of the heterogeneity and polarization of working careers in service society is introduced, highlighting in particular the variety of regulatory forms with their different and changing mixes of family, state and market. These policy mixes form the basis for the various models of welfare capitalism identified here. Finally, consideration is given to the two main responses to this transitional phase in industrialized countries. On the one hand, in English-speaking countries which are characterised by intensive deregulation and the spread of flexible forms of work; on the other hand, in the countries of continental Europe where the redistributive modes of traditional welfare programmes have been preserved. Neither of these strategies, however, has produced new and lasting prospects for synergies between the economy and the society. Potential regulatory innovations would presuppose a reappraisal of modes of activity that are at present 'invisible' such as production for own consumption, family care, volunteer and charitable work and the creation of social capital. Political steps in this direction could lead to a new balance between state, market and family that would secure the level of cooperation needed for socially embedded economic life. -- Der Aufsatz analysiert die gegenwärtigen Schwierigkeiten, mit denen verschiedene Regimes sozialer Regulierung der Wirtschaft konfrontiert sind, einschließlich ihrer Transformationspfade. Um dieser komplexen Fragestellung gerecht zu werden, werden zunächst die allgemeinen Veränderungsprozesse auf dem Arbeitsmarkt dargestellt. Besonderes Gewicht wird dabei auf die Tatsache gelegt, daß der Abbau von lebenslangen Arbeitsverhältnissen das Beschäftigungssystem massiv destabilisiert. Das bezieht sich nicht ausschließlich oder gar vorrangig auf die rückläufigen Beschäftigungsmöglichkeiten. Gleichzeitig sind nämlich im Dienstleistungssektor zahlreiche neue Arbeitsplätze entstanden - wenn auch in der Regel unsichere und schlecht bezahlte. Sie spiegeln ein geringeres Maß gesellschaftlicher Regulierung und implizieren damit eine schwächere soziale Integration sowie ein höheres Risiko sozialer Ausgrenzung. In diesem Zusammenhang werden die Trends zur Heterogenisierung und Polarisierung der Berufsbiographien in der Dienstleistungsgesellschaft thematisiert und dabei besonders die Vielfalt der länderspezifischen Mischungen von Zuständigkeiten von Familie, Staat und Markt dargelegt. Diese bilden die Grundlage für die in diesem Beitrag identifizierten Modelle wohlfahrtsstaatlicher Kapitalismen. Es lassen sich zwei verschiedene Reaktionsmuster der Industriestaaten auf diese Veränderungsprozesse unterscheiden. Auf der einen Seite stehen USA und Großbritannien mit ihren ausgeprägten Deregulierungspolitiken und der Ausweitung von flexiblen Arbeitsverhältnissen; auf der anderen Seite die Länder Kontinentaleuropas, die auf die Beibehaltung der Transferorientierung traditioneller Wohlfahrtsprogramme setzen. Keine dieser Strategien führte jedoch zu neuen und dauerhaften Synergie-Effekten zwischen Wirtschaft und Gesellschaft. Die Möglichkeiten für innovative Regulierungen - so die hier vertretene These - sind daran gebunden, daß bislang 'unsichtbare' Produktionen aufgewertet werden, wie beispielsweise Produktion zum Eigenverbrauch, unbezahlte Tätigkeiten wie Familienarbeit, Solidarität und die Bildung von sozialem Kapital. Ein solcher Ansatz könnte richtungsweisend sein für ein neues regulatives Gleichgewicht, das den Mindestanforderungen an Kooperation Rechnung trägt und damit die Voraussetzung für ein sozial integriertes Wirtschaftsleben gewährleistet.

Impact assessment of an automated drug-dispensing system in a tertiary hospital

OBJECTIVE: To evaluate the costs and patient safety of a pilot implementation of an automated dispensing cabinet in a critical care unit of a private tertiary hospital in São Paulo/Brazil. METHODS: This study considered pre- (January-August 2013) and post- (October 2013-October 2014) intervention periods. We considered the time and cost of personnel, number of adverse events, audit adjustments to patient bills, and urgent requests and returns of medications to the central pharmacy. Costs were evaluated based on a 5-year analytical horizon and are reported in Brazilian Reals (R$) and US dollars (USD). RESULTS: The observed decrease in the mean number of events reported with regard to the automated drug-dispensing system between pre- and post-implementation periods was not significant. Importantly, the numbers are small, which limits the power of the mean comparative analysis between the two periods. A reduction in work time was observed among the nurses and administrative assistants, whereas pharmacist assistants showed an increased work load that resulted in an overall 6.5 hours of work saved/day and a reduction of R$ 33,598 (USD 14,444) during the first year. The initial investment (R$ 206,065; USD 88,592) would have been paid off in 5 years considering only personnel savings. Other findings included significant reductions of audit adjustments to patient hospital bills and urgent requests and returns of medications to the central pharmacy. CONCLUSIONS: Evidence of the positive impact of this technology on personnel time and costs and on other outcomes of interest is important for decision making by health managers