Groups urge ‘no tolerance’ on disruptive behavior

From Modern Healthcare:

Conflict-management training and “no tolerance” policies for disruptive behavior by nurses and physicians are among the recommendations being promoted to improve the working relationships between clinicians.

Two organizations—the American College of Physician Executives and American Organization of Nurse Executives—have developed a set of model policies, online classes and information sources to improve relations and address disruptive behavior.

The collaboration follows the Joint Commission’s new standard, which went into effect Jan. 1, stating that hospital leaders must take steps to address disruptive behavior. Although the policies apply to clinicians of all stripes, physicians have groused at the standard because terms were poorly defined and some fear it could subject them to groundless disciplinary actions.

Feasibility of the Preoperative Mallampati Airway Assessment in Emergency Department Patients

From ScienceDirect (Journal of Emergency Medicine):

Background: Multiple predictors have been proposed to assist in identifying patient features that would predict difficult airway management. The Mallampati score (MS) has been shown to be useful in the preoperative assessment of patients being intubated in the operating room.

Objective: We sought to define the feasibility of this assessment in the Emergency Department.

Methods: A prospective, observational study was performed on all patients being intubated at a university Level I trauma center over a period of 6 months. We recorded and calculated the proportion of patients who were successfully assessed using the MS. Reasons given by individual intubators for failure to assess were recorded. We also tracked patient characteristics between groups and complication rates.

Results: Of 328 patients, 32 (10%) were excluded due to incomplete data. Among the remaining 296, 58% were intubated for non-trauma indications, 70% were male, and the mean age was 45.9 years. Only 76 of 296 (26%) (95% confidence interval 21–31%) were able to have the MS performed. Lack of patient cooperation and clinical instability were listed as factors that precluded evaluation in patients whose assessment was unsuccessful. The frequency of procedure-related minor events did not differ significantly between the assessed and non-assessed groups. Major events included two cricothyrotomies in the non-assessed group.

Conclusions: We were unable to perform a Mallampati assessment in three-quarters of our patients requiring emergency intubation. These findings call into question the feasibility of the standard Mallampati assessment in the practice of Emergency Medicine.

With stimulus, physicians have means to pay for healthcare IT

From Modern Physician:

Physician practices’ need for information technology and the federal government’s willingness to pay for it finally are in sync.

The Congressional Budget Office estimates that the government might pour as much as $38.3 billion into healthcare IT support through 2015 under the American Recovery and Reinvestment Act of 2009. At the same time, the respondents to the 19th annual Modern Physician/Modern Healthcare Survey of Executive Opinions on Key Information Technology Issues say they’re ready to hold out their cups.

Healthcare Kiosk

From Health Blog:

One of the things that has been said about the Internet, healthcare consumerism, social networking, and Web 2.0-3.0 technology is that we may be witnessing the evolution of systems that will one day help us redistribute healthcare resources.

Another example can be seen in work going on at Massachusetts General HospitalDr. Ronald Dixon, Director of the Virtual Practice Project at MGH’s Department of Medicine, and his colleagues are working on a kiosk solution that promises yet another approach to help redistribute and scale medical services.  The kiosk under development is able to take a patient’s medical history and vital signs.  It may also provide simple blood tests like glucose and cholesterol.  Results coming from a patient’s encounter with the kiosk can be electronically forwarded to a nurse or physician for further evaluation and appropriate intervention.  Researchers plan to pilot the kiosk solution later this year in the United Kingdom.

Fewer Openings in Nursing Field

From the Wall Street Journal:

Long term, there is still a need to replace the profession’s aging work force and meet the growing demand for health care — particularly elderly care, a field that usually has trouble attracting nurses. But as is often the case during tough times, former nurses are re-entering the work force after a spouse loses a job. This time, the health-care industry is hurting, too, resulting in fewer positions for nurses. “It’s caused the otherwise severe nursing shortage to abate somewhat,” said Bob Livonius, chief executive of Medfinders, an Arlington, Texas-based staffing firm. His agency, which historically has been able to fill only 70% to 80% of employers’ open positions, is now filling “in the 90s,” Mr. Livonius said.

A recent survey of 658 hospitals by the American Hospital Association found more than half had negative profit margins in the fourth quarter, raising concerns that more layoffs are on the way.

Recession Now Hits Jobs in Health Care

From the Wall Street Journal:

Employment in health care, the only major industry outside the federal government still adding jobs, is succumbing to the recession.

Across the country, hospitals are taking financial hits. They are seeing losses in the portfolios that they rely on for investment income. The number of uninsured patients is rising. Elective procedures — which reap big profits — are down at a third of hospitals nationwide. Nursing homes are trimming payrolls. And with state governments continuing to cut budgets and talk of health-care reform from Washington, industry executives are preparing for even leaner times.

More than 16 million people — one in eight workers on U.S. payrolls — work in health care today, up from just 1% of the work force 50 years ago.

Employment in health care and social assistance — which includes hospitals, doctors offices, nursing homes and social services such as day care — has grown by half a million jobs since the recession began in December 2007, while the rest of the economy has shed 5.1 million jobs

Jobs Scarce, Even for Nurses

From the Washington Post:

For more than a decade as she raised two children, Sue Estes heard one story after another about how hospitals were desperately short of nurses.

They were getting signing bonuses, their pay was soaring to levels unheard of during Estes’s years as a nurse, and bulging benefit packages now included 401(k)s. This year, ready to return to work, she has heard a different story.

“I’ve shipped out résumés everywhere, and I’m not even getting the courtesy callbacks,” said Estes, 43. “All my friends can’t believe it. They’ve read the stories about the shortage, and they say, ‘Places are begging for nurses!’ “