Healthcare Delivery and Finance

Paper Summary:

The paper examines the challenges facing health care services and personnel in the light of changing expectations and the need for reforms to cope with a new reality of health care. The author of the paper focuses on a number of central issues that define health care standards and capabilities all of which arise from a need to reduce costs and suggests possible courses of action. The writer examines the shortage of qualified nursing staff, the change in hospitalization criteria, medical specialization and the need for a unified and standard record keeping system as well as other factors demanding revision and change.

From the Paper:

"Patients are suffering because of the decrease in quality of care and the effect of low nursing staff on their safety. Several patient outcomes are influenced by the kind of nursing care a patient receives. These are urinary tract infections, pneumonia, shock, upper gastrointestinal bleeding, longer hospital stays and a thirty-day mortality (Stanton & Rutherford, 2004). It was found that hospitals with more nurses had lower outcomes of the aforementioned diseases in patients. A 2 to 25% reduction in adverse outcomes was related to the number of nurses in their staff. Of all the adverse outcomes, it was found that pneumonia was most sensitive to the number of nurses and the number of nursing hours per patient a day (NHPPD). An increase in NHPPD by half an hour could reduce the occurrence of pneumonia in surgical patients by over 4%. An increase in the nursing staff by 10% could decrease the occurrence of pneumonia by at least 9%. This reflects the dependence of patients to the nursing staff with regards to respiratory care. Thirty-day mortality rates were 7% higher in hospitals where the nurse to patient ratio was at most 4:1. One solution to this ongoing problem is the redesign of hospitals by putting acuity-adaptable rooms for patients that are qualified for admission in progressive care units (Hendrich et al., 2004). These are patients who may require the use of a mechanical ventilation, vasopressors, or continuous monitoring, or manifest with altered level of consciousness or altered fluid status. These are patients who are low risk compared to those confined in critical care units (CCU), but they require constant monitoring. However, since there is a lack of progressive care units, these low risk patients are placed in the CCU. As a result, patients are constantly being moved depending on their current needs and availability of rooms for other critically-ill patients. These acuity-adaptable rooms, termed Cardiac Comprehensive Critical Care (CCCC) units, resulted in a reduction in transferring patients by 90%. Medication errors were reduced by 70%, and fall index significantly decreased. Patients are more satisfied with the quality of care they are receiving, and the amount of time allotted to transferring patients by nurses are used more efficiently, allowing to reduce in staffing care hours."

Sample of Sources Used:

• Blumenthal, D. & Glazer, J.P. (2007, June 14). "Information technology comes to medicine." The New England Journal of Medicine, 356(24): 2527-2534.
• Califf, R.M. & Muhlbaier, L.H. (2003, August 26). "Health Insurance Portability and Accountability Act (HIPAA): Must there be a trade-off between privacy and quality of health care, or can we advance both?" Circulation, 108: 915-918.
• Dunnigan, M.G. & Pollock, A.M. (2003, April 26). "Downsizing of acute inpatient beds associated with private finance initiative: Scotland's case study." BMJ, 326: 1118-1123.
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• Hendrich, A.L., Fay, J. & Sorrells, A.K. (2004, January). "Effects of acuity-adaptable rooms on flow of patients and delivery of care." American Journal of Critical Care, 13(1): 35-45.

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