Hospital wards (2): occupation, weekends and safety

In the last Monday’s post, I was referring to the organizational quality, the provision for the medical guard and the coordination of professionals with the clinical safety of patients, and this second part of the same subject of hospitalization wards, I was left with a couple of things to deal with, also related to the quality of care: the stress caused by the large workload and the lack of services during the weekends.

The high occupancy of the wards increases mortality

A group from the University of Cologne, with the collaboration of Cambridge, has conducted a study in 83 German hospitals with more than 80,000 patients with pathologies of risk and have concluded that the tipping point for a hospital ward is 92,5%, occupation, a figure from which, the chaos inherent in the situation created by the excess patients, generates a significant increase in mortality.

"If a hospital regularly works above the tipping point, says professor Stefan Scholte's in the Cambridge University blog, you can bet that it has a structural quality problem, but what we need to be wary of, is those hospitals reaching the tipping point occasionally but repeatedly, generating risk situations for patients who are not normally detected by the aggregate statistics."

Hospital wards (1): nurses and clinical safety

Often, when we talk about clinical safety, we refer to specific activities such as hand washing or surgical checklist, but in this post I will try to explain the repercussions that the methods of working in hospital wards have on the quality of care. When people are admitted to a hospital, they put themselves in the hands of an army of professionals, who follow guidelines and are subject to shifts and medical guards. We must pay attention to all this, because the evidence has been warning us that what we call organizational factors weigh more than we think when it comes to hospitalized people’s health.

The 12-hour shifts are less secure for patients than the 8 hours shifts

A study conducted by the University of Maryland concludes that the probability of error is 3 times higher for nurses who work in 12-hour shifts compared to the one who work on 8 hours shifts. This finding has been corroborated by extensive research (22,000 records) conducted by the School of Nursing at the University of Pennsylvania.

The chronic patients’ care needs disruption and no reforms

Clayton Christensen, a professor at Harvard Business School, defines disruptive innovation as a process that, by simplifying a product or service, is expanding the markets until the new products or services manage to get better than the originals that are obviously heavier and more expensive. Disruptive technologies have simplified products, made them cheaper and thus have brought millions of new consumers to the market. Such is the economy of the new millennium.

In The Innovator's Prescription, Christensen says that the health system lacks disruptive innovation, that hospitals concentrate too many specialists, too much investment and too much technology; and according to him, this accumulation is an obstacle to the arrival of more simple services, but perhaps more effective in larger populations.

Virtual Units: a model to prevent hospital readmissions?

Glòria Galvez

Hospital readmissions are one of the expressions of the complex relationship between the different levels of care, as well as an important indicator of quality. Many of these readmissions are unavoidable and justified, but many of them are inadequate and could be prevented by changes in the care protocol of the registered patient. Even so, an intervention to reduce readmissions has not been found yet.

In an issue of JAMA magazine, Dr. Dhalla, an internist at St. Michael Hospital and professor at the University of Toronto, evaluates and compares the results of a virtual unit with those obtained by providing routine care to reduce readmissions and deaths after hospital discharge. The virtual units were created in 2004 in the United Kingdom for their alleged potential to reduce hospital readmissions, but had not yet been rigorously evaluated. The basic idea is simple: it’s about using already proven care systems from the hospital setting (equipment, coverage, access, etc.) and applying them to complex and high-risk patients in their own homes.