DiversityNursing Blog

See How Nurses Are Doing Less Walking And More Caring

Posted by Pat Magrath

Thu, Feb 16, 2017 @ 11:11 AM

graduates-nursing-bsn.jpgEvery Nurse I know who works in a hospital, says they are amazed how much walking they do in their 12-hour shift. If you wear a Fitbit or another step tracking device, you know you walk miles during your shift. Here’s a story about a hospital that did a study to see where they could eliminate some steps for Nurses in the design of their new building.
 
The goal was to give Nurses more time to deliver the best patient care. If you have to walk all over the building to fulfill a medication order, perhaps there is a better way to do it with less steps. Maybe the applesauce or ginger ale could be located closer to where the medicine is dispensed. Please read on for some valuable information.

You don't know what you don't know until you know it.

That's the lesson leaders at ProMedica Toledo Hospital in Ohio learned during the design of its 615,000 square-foot patient tower set to 2019.

As part of the design process, the organization took part in research to identify and refine ways to improve nursing care and efficiencies, including distance traveled during a shift.

Architects from HKS, Inc., the firm designing the building, approached Alison Avendt, OT, MBA, vice president of operations, at ProMedica Toledo Hospital about doing the research.

"We have a building that we opened in 2008, so they wanted to look at how we were using the spaces [there], and get feedback from nursing on how it was working," Avendt says.

"That was really attractive to me because I heard we had issues with the building that we were in and there were many things that we wish we could have done better. I thought if we could do a good design diagnostic and learn something from that, it would really help guide our design work."

An Applesauce Moment
During two days of onsite observation, researchers shadowed ICU nurses and intermediate-level medical-surgical nurses. The researchers assessed the existing floor plan, used a parametric modeling tool, and created heat maps to provide a graphic representation of what a nurse's 12-hour shift looked like in terms of workflow and walking distances.

"One of the big [revelations] was around our whole process of medication passing," says Deana Sievert, RN, MSN, metro regional chief nursing officer and vice president for patient care services at ProMedica.

Observation revealed that a nurse reviewed the patient's medication administration record in the patient's room, walked to the supply room to get the medication from the Pyxis machine, and then often had to stop by the patient refrigerator to get something—like applesauce—to aid in the medication pass before walking back to the patient's room to administer the medication.

"It was something that was just so ingrained in our staff nurses' normal daily activities," Sievert says. "When they did the heat mapping it was like…'Wow. [There's a] big pinch point that we as staff nurses didn't really even realize was there.' "

Avendt says the researcher called this realization "the applesauce moment."

"Nurses are masterful at just making things work. There are a lot of things that the nurses knew were not value-added or were problematic, but they would just make it work," she says.

"It was really good to flesh out what those things were by observing because if you just ask[ed] them, the nurse would often not be able to verbalize what the problem was. But by seeing it, it came to light."

The architects used this information to design a unit that would cut down on walking time. Instead of a long corridor with a common area at one end, the unit was broken up into pods and supplies were located in multiple areas so nurses could get them from the location to which they were closest.

"We were able to take them from a three-mile journey on their shift to 1.5 miles. We cut in half the steps that they were taking," Avendt says.

After the tower opens, more research will be done to see how the design is affecting workflow.

"We've since learned that [field research] is not common for people to do. We paid a little bit of money to do that, but in the scheme of things it was well worth the investment," Avendt says.

"Everybody wants to give the nurse as much time as possible to be with the patient [and] try to take away the things that are not value-added in the nurse's day."

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Topics: efficiency, patient care, hospitals, Nurse burnout

Demand For Travel Nurses Hits A 20-Year High

Posted by Erica Bettencourt

Wed, May 27, 2015 @ 02:03 PM

Phil Galewitz

www.usatoday.com 

635679001184311388 Cherisse Dillard Travel Nurse resized 600With her children grown and husband nearing retirement, Amy Reynolds was ready to leave behind snowy Flagstaff, Ariz., to travel but she wasn't ready to give up her nursing career.

She didn't have to.

For the past three years, Reynolds, 55, has been a travel nurse – working for about three months at a time at hospitals in California, Washington, Texas and Idaho, among other states. Her husband accompanies her on the assignments. "It's been wonderful," she said in May after starting a stint in Sacramento. "It's given us a chance to try out other parts of the country."

Reynolds is one of thousands of registered nurses who travel the country helping hospitals and other health care facilities in need of experienced, temporary staff.

With an invigorated national economy and millions of people gaining health coverage under the Affordable Care Act, demand for nurses such as Reynolds is at a 20-year high, industry analysts say. That's meant Reynolds has her pick of hospitals and cities when it's time for her next assignment. And it's driven up stock prices of the largest publicly traded travel-nurse companies, including San Diego-based AMN Healthcare Services and Cross Country Healthcare of Boca Raton, Fla.

"We've seen a broad uptick in health care employment, which the staffing agencies are riding," said Randle Reece, an analyst with investment firm Avondale Partners. He estimates the demand for nurses and other health care personnel is at its highest level since the mid-1990s.

Demand for travel nursing is expected to increase by 10% this year "due to declining unemployment, which raises demand by increasing commercial admissions to hospitals," according to Staffing Industry Analysts, a research firm. That trend is expected to accelerate, the report said, because of higher hospital admissions propelled by the health law. 

Improved profits — particularly in states that expanded Medicaid — have also made hospitals more amenable to hire travel nurses to help them keep up with rising admissions, analysts say.

At AMN Healthcare, the nation's largest travel-nurse company, demand for nurses is up significantly in the past year: CEO Susan Salka said orders from many hospitals have doubled or tripled in recent years. Much of the demand is for nurses with experience in intensive care, emergency departments and other specialty areas. "We can't fill all the jobs that are out there," she said.

Northside Hospital in Atlanta is among hospitals that have recently increased demand for travel nurses, said David Votta, manager of human resources. "It's a love-hate relationship," he said. From a financial viewpoint, the travel nurses can cost significantly more per hour than regular nurses. But the travel nurses provide a vital role to help the hospital fills gaps in staffing so they can serve more patients. 

Northside is using 40 travel nurses at its three hospitals, an increase of about 52% since last year. The system employs about 4,000 nurses overall. 

Historically, the most common reason why hospitals turn to traveling nurses is seasonal demand, according to a 2011 study by accounting firm KPMG. Nearly half of hospitals surveyed said seasonal influxes in places such as Arizona or Florida, where large numbers of retirees flock every winter, led them to hire traveling nurses. 

Though there have been rare reports of travel nurses involved in patient safety problems, a 2012 study by researchers at the University of Pennsylvania published in the Journal of Health Services Research found no link between travel nurses and patient mortality rates. The study examined more than 1.3 million patients and 40,000 nurses in more than 600 hospitals. "Our study showed these nurses could be lifesavers. Hiring temporary nurses can alleviate shortages that could produce higher patient mortality," said Linda Aiken, director of the university's Center for Health Outcomes and Policy Research. The study was funded by the National Institutes of Health and the American Staffing Association Foundation.

The staffing companies screen and interview nurses to make sure they are qualified, and some hospitals, such as Northside, also make their own checks. Nurses usually spend a couple days getting orientated to a hospital and its operations before beginning work. They have to be licensed in each state they practice in, although about 20 states have reciprocity laws that expedite the process.

Cherisse Dillard, a labor and delivery room nurse, has been a traveler for nearly a decade. In the past few years, she's worked at hospitals in Chicago, Dallas, Houston, Pensacola and the San Francisco area.

While delivering a baby is relatively standard practice, she said she makes it a practice at each new hospital to talk to doctors and other staff to learn what their preferences are with drugs and other procedures. Dillard, 46, often can negotiate to be off on weekends and be paid a high hourly rate. "When the economy crashed in 2008, hospitals became tight with their budget and it was tough to find jobs, but now it's back to full swing and there are abundant jobs for travel nurses," she said.

Topics: health coverage, affordable care act, healthcare, RN, nurse, nurses, hospitals, travel nurse, travel nurses

Your Roommate In The Nursing Home Might Be A Bedbug

Posted by Erica Bettencourt

Tue, May 26, 2015 @ 03:09 PM

ANGUS CHEN

www.npr.org 

hospital bed custom 6b164486756a615b302de54c474c2361d4c33e1f s800 c85 resized 600If you're in the hospital or a nursing home, the last thing you want to be dealing with is bedbugs. But exterminators saying they're getting more and more calls for bedbug infestations in nursing homes, hospitals and doctor's offices.

Nearly 60 percent of pest control professionals have found bedbugs in nursing homes in the past year, according to an industry survey, up from 46 percent in 2013. Bedbug reports in other medical facilities have gone up slightly. Thirty-six percent of exterminators reported seeing them in hospitals, up from 33 percent. Infestations seen in doctors' offices rose from 26 percent to 33 percent in the past two years.

"Nursing homes would be difficult to treat for the simple reason you don't use any pesticides there," says Billy Swan, an exterminator who runs a pest-control company in New York City. That and the fact that there's a lot more stuff. "Somebody's gotta wash and dry all the linens, you know, and all their personal artifacts and picture frames."

Those personal belongings might help account for the big disparity in infestations between nursing homes and hospitals, according to Dr. Silvia Munoz-Price, an epidemiologist at the Medical College of Wisconsin who studies infection control in health care facilities. "The more things you bring with you, the more likely you're bringing bedbugs, if you have a bedbug problem... and you live in a nursing home, so all your things are there."

By contrast, "When bedbugs are located in a hospital, they're usually confined to a couple of hospital rooms," Munoz-Price says.

And it may be easier for hospital staff to spot bedbugs.

"Hospital cleaning staff, nurses, doctors are extremely vigilant," says Jim Fredericks, chief entomologist for the National Pest Management Association, which conducted the survey along with the University of Kentucky. "[Bedbugs] don't go unnoticed for long."

And hospitals are typically brightly lit, routinely cleaned places. It's just much easier to find pests in this setting than in a dark movie theater, where only 16 percent of pest professionals report seeing bedbugs, according to the survey.

Fredericks says the recent multiplication of bedbug reports in medical facilities is just a part of a larger trend. Exterminators have been finding more of the bugs everywhere the parasites are most commonly found like hotels, offices, and homes, where virtually 100 percent of pest control professionals have treated bedbugs in the past year. And they've been popping up in a few unexpected places, too, like a prosthetic leg and in an occupied casket.

"There are a lot of theories as to why they've made a comeback," Fredericks says. It could be differences in pest management practices, insecticide resistance, or just increased travel. "Bottom line is nobody knows what caused it, but bedbugs are back." He falters for a moment. "And they're most likely here to stay."

The good news is bedbugs aren't known to transmit any diseases, and a quick inspection under mattresses or in the odd nook or cranny while traveling can lower the risk of picking the hitchhiking bugs up. Swan says a simple wash or freezing will kill any bedbug. "If you came home, took off all your clothes, put 'em in a bag – you'd never bring a bedbug home," he says. "But who does that?"

At least one reporter might start.

Topics: health, healthcare, nurse, nurses, patients, patient, treatment, hospitals, nursing homes, bed bugs

When You Have The 'Right To Die,' But Don't Want To`

Posted by Erica Bettencourt

Tue, May 26, 2015 @ 02:26 PM

By Stephanie O'Neill

www.cnn.com 

150525102957 packer family 2 exlarge 169 resized 600Stephanie Packer was 29 when she found out she has a terminal lung disease.

It's the same age as Brittany Maynard, who last year was diagnosed with terminal brain cancer. Maynard, of northern California, opted to end her life via physician-assisted suicide in Oregon last fall. Maynard's quest for control over the end of her life continues to galvanize the "aid-in-dying" movement nationwide, with legislation pending in California and a dozen other states.

But unlike Maynard, Packer says physician-assisted suicide will never be an option for her.

"Wanting the pain to stop, wanting the humiliating side effects to go away -- that's absolutely natural," Packer says. "I absolutely have been there, and I still get there some days. But I don't get to that point of wanting to end it all, because I have been given the tools to understand that today is a horrible day, but tomorrow doesn't have to be."

A recent spring afternoon in Packer's kitchen is a good day, as she prepares lunch with her four children.

"Do you want to help?" she asks the eager crowd of siblings gathered tightly around her at the stovetop.

"Yeah!" yells 5-year-old Savannah.

"I do!" says Jacob, 8.

Managing four kids as each vies for the chance to help make chicken salad sandwiches can be trying. But for Packer, these are the moments she cherishes.

Diagnosis and pain

In 2012, after suffering a series of debilitating lung infections, she went to a doctor who diagnosed her with scleroderma. The autoimmune disease causes hardening of the skin and, in about a third of cases, other organs. The doctor told Packer that it had settled in her lungs.

"And I said, 'OK, what does this mean for me?'" she recalls. "And he said, 'Well, with this condition...you have about three years left to live.'"

Initially, Packer recalls, the news was just too overwhelming to talk about with anyone --including her husband.

"So we just...carried on," she says. "And it took us about a month before my husband and I started discussing (the diagnosis). I think we both needed to process it separately and figure out what that really meant."

Packer, 32, is on oxygen full time and takes a slew of medications.

She says she has been diagnosed with a series of conditions linked to or associated with scleroderma, including the auto-immune disease, lupus, and gastroparesis, a disorder that interferes with proper digestion.

Packer's various maladies have her in constant, sometimes excruciating pain, she says, noting that she also can't digest food properly and is always "extremely fatigued."

Some days are good. Others are consumed by low energy and pain that only sleep can relieve.

"For my kids, I need to be able to control the pain because that's what concerns them the most," she adds.

Faith and fear

Packer and her husband Brian, 36, are devout Catholics. They agree with their church that doctors should never hasten death.

"We're a faith-based family," he says. "God put us here on earth and only God can take us away. And he has a master plan for us, and if suffering is part of that plan, which it seems to be, then so be it."

They also believe if the California bill on physician-assisted suicide, SB 128, passes, it would create the potential for abuse. Pressure to end one's life, they fear, could become a dangerous norm, especially in a world defined by high-cost medical care.

"Death can be beautiful"

Instead of fatal medication, Stephanie says she hopes other terminally ill people consider existing palliative medicine and hospice care.

"Death can be beautiful and peaceful," she says. "It's a natural process that should be allowed to happen on its own."

Stephanie's illness has also forced the Packers to make significant changes. Brian has traded his full-time job at a lumber company for that of weekend handyman work at the family church. The schedule shift allows him to act as primary caregiver to Stephanie and the children. But the reduction in income forced the family of six to downsize to a two-bedroom apartment it shares with a dog and two pet geckos.

Even so, Brian says, life is good.

"I have four beautiful children. I get to spend so much more time with them than most head of households," he says. "I get to spend more time with my wife than most husbands do."

And it's that kind of support from family, friends and those in her community that Stephanie says keeps her living in gratitude, even as she struggles with the realization that she will not be there to see her children grow up.

"I know eventually that my lungs are going to give out, which will make my heart give out, and I know that's going to happen sooner than I would like — sooner than my family would like," she says. "But I'm not making that my focus. My focus is today."

Stephanie says she is hoping for a double-lung transplant, which could give her a few more years. In the meantime, next month marks three years since her doctor gave her three years to live.

So every day, she says, is a blessing.

Topics: assisted suicide, Right-to-die, health, healthcare, nurses, doctors, hospitals, medica, medical laws, physician assisted suicide

Time to Prove Hospital Disinfectants Work, FDA Says

Posted by Erica Bettencourt

Tue, May 05, 2015 @ 12:21 PM

BY MAGGIE FOX

www.nbcnews.com 

nc handwashin 140130 d2a038564c98deb8fe0d0a9589bd78b7.nbcnews fp 1440 600 resized 600Hospital workers wash their hands hundreds of times a day. Nurses are constantly using alcohol gels, chemical wipes and iodine washes on themselves and on patients.

Now that there's a hand sanitizer dispenser at every hospital room door, it's time to check that they actually do work as well as everyone assumes and that they are safe, the Food and Drug Administration says.

Up until now, FDA's just accepted that these products work as intended and are safe. But now, FDA says, there are tests available to actually prove they do. And because of the emphasis on hospital infections, institutions are using the products far more frequently than even 10 years ago and in many different ways.

So FDA issued a proposed plan Thursday for reclassifying some of the products, and for requiring makers to show they are safe and effective.

"We're not asking for any of these products to come off the market at this time."

In the meantime. FDA says, there's nothing for consumers to worry about and hospitals should continue using the products as they have been.

"What it seems they are doing is good due diligence," says Dr. Susan Dolan of Children's Hospital Colorado and the Association of Professionals in Infection Control.

"They are trying to look at the products, look at how they are being used today, how things have changed," she added.

The FDA proposes new rules making companies submit new studies looking at safety issues such as whether heavy, chronic use of the some of the products may cause them to soak in through the skin, or cause resistant bacteria to evolve.

Products that are not shown to be safe and effective by 2018 would have to be reformulated or taken off the market.

"We're not asking for any of these products to come off the market at this time. We're just asking for additional data," Theresa Michele, a director in FDA's drug center, said in an interview with The Associated Press. "And we're likewise not suggesting that people stop using these products."

Alcohol, iodine benzalkonium chloride and other germ-killers have been used for decades. But not to the degree that they are now.

"Twenty years ago you didn't find people using antiseptic gels 100 times a day. It just didn't happen," Michele said.

FDA points to studies that show some of the products might be absorbed into the body at higher levels than previously thought, showing up in blood and urine. Dolan says not all the studies show this, but it's worthwhile doing more checks.

"It's timely and it makes sense," Dolan said. "I do think consumers should not be worried. These are very effective products."

The FDA last updated its review of health care hand cleaners in 1994.

"They are trying to look at the products, look at how they are being used today, how things have changed."

"We emphasize that our proposal for more safety and effectiveness data for health care antiseptic active ingredients does not mean that we believe that health care antiseptic products containing these ingredients are ineffective or unsafe, or that their use should be discontinued," FDA said in its announcement.

The agency agreed to complete its review after a three-year legal battle with the Natural Resources Defense Council, an environmental group that accused the FDA of delaying action on potentially dangerous chemicals. In 2013 the FDA agreed to a legal settlement that included timetables for completing the review of various chemicals, including health care cleaners.

Environmentalists are mainly concerned about an ingredient called triclosan, which is used in most antibacterial soaps marketed to consumers. The agency issued a separate review of triclosan-containing consumer products in late 2013, saying more data are needed to establish their safety and effectiveness.


Topics: FDA, health, safety, nurses, doctors, medical, patients, hospitals, hand sanitizer, disinfectants

FDA Revisits Safety Of Health Care Antiseptics Such As Purell

Posted by Erica Bettencourt

Fri, May 01, 2015 @ 11:51 AM

www.foxnews.com 

hand sanitizer istock660 resized 600After roughly 40 years, U.S. health regulators are seeking data to see if the cocktail of ingredients in antiseptics used in hospitals, clinics and nursing homes are as safe and effective as they were once considered.

The Food and Drug Administration said on Thursday it is asking manufacturers for more data, including on absorption, potential hormonal effects and bacterial resistance of thehe 'active' ingredients in antiseptics, to see if they are still appropriate for use in a health care setting.

Since the review of health care antiseptics in the 1970s, things have changed, the FDA noted, alluding to a shift in frequency of use, hospitals' infection control practices, technology and safety standards. (1.usa.gov/1EUrzCd)

An independent panel of experts to the FDA raised similar concerns last year. In 2013, the regulator issued a warning to manufacturers, saying it was aware of at least four deaths and multiple infections caused by over-the-counter antiseptics. (1.usa.gov/1DNxOSp)

Commonly used active ingredients in health care antiseptics include alcohol and iodine. Data suggests that, for at least some of these ingredients, the systemic exposure is higher than previously thought, the agency noted.

"We're going to try to answer their questions in great detail as called for, but we believe the FDA already has sufficient data on these products," said Brian Sansoni, a spokesman for American Cleaning Institute (ACI), a trade association for the cleaning products industry.

The ACI represents antiseptic ingredient and product makers such as Gojo Industries Inc, the maker of Purell hand sanitizers; Dial Corp, a unit of Germany's Henkel (HNKG_p.DE); Ecolab Inc and Steris Corp.

The FDA said no health care antiseptics were going to be pulled off shelves as of now, and that their review excluded home-use antiseptics such as antibacterial soap and hand sanitizers.

The new data request relates only to health care antiseptics covered by the over-the-counter monograph, a kind of "recipe book" covering acceptable ingredients, doses, formulations and labeling. Once a final monograph is implemented, companies can market their product without having to go through the FDA.

Companies will have one year to submit the data, which the FDA will evaluate before determining if the OTC monograph needs to be revised.

"We're concerned if the FDA takes maybe a too narrow view regarding the safety and effectiveness data – depending how the final rule ends up – they could take effective products or ingredients off the shelves," Sansoni said.

Topics: FDA, nursing, nurses, doctors, data, medical, hospital, hospitals, clinics, antiseptics, Purell, sanitizers, nursing homes

The Great American Kidney Swap

Posted by Erica Bettencourt

Fri, May 01, 2015 @ 11:41 AM

By 

www.nytimes.com 

03kidney ss slide U201 superJumbo v2 resized 600Before surgeons stitched a kidney from a 32-year-old former Marine into his abdomen in March, Mark Kim spent almost two years on dialysis. He had lot of time to think while hooked up to the machine, three times a week, as it pumped his blood out of his body, purified it and pumped it back in. Sometimes he found himself mulling over how odd it was that a new kidney — the one thing he needed most — was something money couldn’t buy.

When his kidneys first failed him, all sorts of people offered to donate one: his neighbor, his two 20-something nieces, two old friends, his sister. But none could follow through, mostly because of incompatible blood types. Such supply-and-demand mismatches can cause prices to skyrocket in a normal market, and indeed, Kim heard hints about the organ’s economic value along the way. Once, at a backyard barbecue, a woman whispered to him that her mother purchased a kidney on the black market for $100,000.

Despite the crushing demand, the sale of kidneys is banned in every country in the world except Iran. In the U.S., more than 100,000 people with renal failure are on the list for a deceased-donor kidney, typically waiting between four and five years. Last year, 4,270 people died waiting. Few but free-market absolutists would argue for repealing the 1984 law banning the organ trade in the U.S., but most would agree something should be done to increase the supply of kidneys for transplant. In a sense, though, there’s already a global glut: While we are born with two kidneys, we can function just fine with one. The problem is that they’re stuck inside of us.

Kim would have continued to wait on the national list, despite having several willing donors, were it not for a company called BiologicTx. Thanks to its software, Kim was able swap his sister’s kidney for the Marine’s kidney. The Marine, a woman named Liz Torres, gave up her kidney to ensure that her mother got a kidney, which came from a young social worker, Ana Tafolla Rios, who was a better match. Rios passed hers along to secure one for her ailing mother from Keith Rodriguez, a young man from Fresno. He let go of his to procure one for his mom, Norma, a 52-year-old dental assistant with polycystic kidney disease. All these people underwent surgery over two days in March at the California Pacific Medical Center in San Francisco, in what is called a kidney-transplant chain. The software programs driving such chains create something like a marketplace for organs — but one where supply and demand are balanced not through pricing but through altruism.

A law-abiding American in need of a kidney has two options. The first is to wait on the national list for an organ donor to die in (or near) a hospital. The second is to find a person willing to donate a kidney to you. More than half the time, such donor-and-recipient pairs are incompatible, because of differences in blood type or the presence, in the donor’s blood, of proteins that might trigger the recipient’s immune system to reject the new kidney. The genius of the computer algorithms driving the kidney chains is that they find the best medical matches — thus increasing the odds of a successful transplant — by decoupling donors from their intended recipients. In the United States, half a dozen of these software programs allow for a kind of barter market for kidneys. This summer, doctors will most likely complete the last two operations in a record-breaking 70-person chain that involved flying donated kidneys on commercial airlines to several hospitals across the country.

Garet Hil, the founder and chief executive of the National Kidney Registry, the largest kidney-chain exchange program in the world, has a background in financial services, not medicine. He borrowed concepts from the brokerage industry when developing the registry’s algorithm. Hil founded the organization after the emotionally grueling experience of obtaining a kidney for his 10-year-old daughter. After seven family members, including Hil and his wife, volunteered to donate theirs, all seven were found to be a poor match. (Eventually they found a compatible cousin.)

Each chain starts with a completely altruistic donor, someone who expects nothing in return. In the case of the San Francisco chain, that person was Zully Broussard, a 55-year-old mental-health nurse who works in a prison. Broussard lost her 21-year-old son to bone-cartilage cancer in 2001. Then, in 2013, her husband died of colon cancer. “I know what it is to want an extra hour, an extra day, with someone you love,” she told me. Directed by the algorithm, Broussard’s kidney ended up inside a complete stranger, a 26-year-old factory worker, Oswaldo Padilla, with a 6-year-old daughter, setting off the 12-person chain that included Kim and his sister and ended with an interior designer named Verle Breschini.

Economists call an arrangement like this a matching market. “It is not fundamental to economic theory to assume people are selfish,” Alvin E. Roth, an economist who teaches at Stanford University, told me. Roth won the Nobel Prize in economics in 2012 for his work using game theory to design matching markets, which pair unmatched things in mutually beneficial ways — students with public schools and doctors with hospitals. In such markets, money does not decide who gets what. Instead, these transactions are more akin to elaborate courtships.

The classic example of a matching market is the college-admissions process. Every year, tens of thousands of students apply to Harvard University. But just because a student wants a spot in the freshman class and can afford tuition does not mean he gets in. Harvard must also wanthim to attend. In the case of kidney exchange, this matchmaking happens at a microcellular level. White blood cells contain genetic markers, proteins that help our immune systems distinguish between our bodies and foreign invaders. The more closely a transplant recipient’s genetic markers match a donor’s, the more likely the body is to adopt that foreign kidney as its own rather than attacking it.

All these genetic variables mean that linking unrelated donors and recipients requires the kind of computational heft humans can’t manage with pen and paper. For example, BiologicTx currently has 72 people in a computer database waiting to give or receive a kidney. Run the software to find biologically compatible matches among those 72 people, and you get 105,716 possible configurations — some long chains, others short. Some people in the database have no possible matches. Others, genetically blessed, have thousands of potential matching options within the pool. The software ranks those possible pairings based on hundreds of different immunological, genetic and demographic criteria, while also aiming to create longer chains of harder-to-match people which will ultimately result in more transplants.

Last year in the United States, 544 kidneys were transplanted through these paired exchange programs, and many other countries are beginning to adopt them. Surgeons in Poland, Italy and Argentina completed their first chains last year. As more donor-and-recipient pairs enroll, the chains can accommodate increasingly complicated transactions. In December, for example, a transplant surgeon at U.C.L.A. removed the kidney from a grandfather who donated on behalf of his young grandson. The boy suffers from chronic kidney disease, but his doctors have determined he does not yet require a transplant. The grandfather feared that if he waited the five or 10 years until the boy needed the kidney, he would be too old to donate. So the boy and his grandfather joined the National Kidney Registry, using the grandfather’s kidney to kick off a chain, thereby securing a kidney for the boy, who will be the last recipient in another chain at some unspecified future date.

Mark Kim had his operation two months ago, and ever since, people have been telling him that his voice seems different, that somehow he sounds more alive. And at a biological level, every cell in his body feels better. But that vitality extends beyond his physical well-being. He is now one link in a visceral chain of sacrifice and benefit. It feels, to him, a little bit like kinship.

Topics: America, health, healthcare, hospitals, transplant, black market, kidney, donors, organ donors

The State of Women in Healthcare: An Update

Posted by Erica Bettencourt

Mon, Mar 30, 2015 @ 10:11 AM

Halle Tecco

Source: http://rockhealth.com 

Exactly a year ago, we decided to publish the gender data on founders at Rock Health. Despite women being the majority of our team and our board, only 30% of our portfolio companies had a female founder (today, we are at almost 34%). Because we’d like to help our portfolio companies access a diverse talent pool, we began the XX in Health initiative nearly four years ago.

The aim of this initiative is to bring women together to network and support one another. The 2,400 members of the group share resources and ideas on LinkedIn and meet regularly across the country. This week we’re hosting a webinar on the topic for both men and women, and next week we’ll host our sixth XX in Health Retreat in NYC.

Today, through this initiative, we are proud to share our third annual report on the state of women in healthcare. Our past reports on this topic have been some of our most popular content, and we encourage you to share this report with your colleagues.

Women are still underrepresented in leadership positions in healthcare.

Despite making up more than half the healthcare workforce, women represent only 21% of executives and 21% of board members at Fortune 500 healthcare companies. Of the 125 women who carry an executive title, only five serve in operating roles as COO or President. And there’s only one woman CEOof a Fortune 500 healthcare company.

Hospital diversity fares slightly better. At Thomson Reuters 100 Top Hospitals, women make up 27% of hospital boards, and 34% of leadership teams. There are 97 women that carry a C-level title at these hospitals and 10 women serve as hospital CEO.

We know from our funding data that women make up only 6% of digital health CEOs funded in the last four years. When we looked at the gender breakdown of the 148 VC firms investing in digital health, we understood why. Women make up only 10% of partners, those responsible for making final investment decisions. In fact, 75 of those firms have ZERO women partners (including Highland CapitalThird RockSequoiaShasta Ventures). Venture firms with women investment partners are 3X more likely to investin companies with women CEOs. It’s no wonder women CEOs aren’t getting funded.

The problem is real, and the problem matters.

We surveyed over 400 women in the industry to better understand the sentiment around gender discrimination. 96% of the women we surveyed believe gender discrimination still exists. And almost half of them cited gender as one of the biggest hurdles they’ve faced professionally.

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Often these are micro-inequities that compound over one’s career. MIT Professor Mary Rowe describes these instances as “apparently small events which are often ephemeral and hard-to-prove, events which are covert, often unintentional, frequently unrecognized by the perpetrator.” But they create work environments which hold women back.

When senior women are scarce in an organization, a vicious cycle of  “second-generation” gender bias kicks in. Researchers describe this bias as barriers that “arise from cultural assumptions and organizational structures, practices, and patterns of interaction that [put] women at a disadvantage.” Fewer women leaders means fewer role models for would-be women leaders. On the flip side, when women who are early in their career see more women in senior leadership positions, it sends the message that they too belong in the C-suite.

The good news is that achieving diverse leadership teams is not just a moral imperative, it’s good for business too.

Having a diverse team creates a positive, virtuous cycle. Companies with women CEOs outperform the stock market, and companies with women on their boards outperform male-only boards by 26 percent. Researchers even estimate that transitioning from a single-gender office to an office evenly split between men and women be associated with a revenue gain of 41%.

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Not only do companies with more women in leadership yield better economic returns, recent research also suggests it helps mitigate risk. One study shows that each additional female director reduces the number of a company’s attempted takeover bids by 7.6%. Another study indicates that companies with more women on their board had fewer instances of governance-related scandals such as bribery, corruption, fraud, and shareholder battles.

Let’s get together and support one another.

Empower your colleagues to promote gender equality in the workplace. This month we challenge you to reach out to that mentor, manager, peer, or mentee with whom you’ve been meaning to connect with. Ask her to grab coffee and send us a picture by April 30 so we can share it on the XX in Health website!

Topics: women, gender, ceo, health, healthcare, hospitals, positions, digital health, gender discrimination, office

Stroke Centers 'Over An Hour Away' For One Third of Americans

Posted by Erica Bettencourt

Fri, Mar 06, 2015 @ 11:05 AM

James McIntosh

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It is vital that treatment for stroke is given as quickly as possible in order to minimize the amount of long-term damage that occurs. Unfortunately, a new study has suggested that one third of Americans would be unable to access a primary stroke center within 1 hour should they need to.

The study, published online in Neurology, was a population-level virtual trial simulating how long it would take for patients to access stroke care following changes to systems of treatment.

"Research has shown that specialized stroke care has the potential to reduce death and disability," says study author Dr. Michael T. Mullen. "Stroke is a time-critical disease. Each second after a stroke begins, brain cells die, so it is critically important that specialized stroke care be rapidly accessible to the population."

According to the authors, stroke is one of the leading causes of death and disability in the US, occurring when the flow of blood to a portion of the brain is blocked or an artery in the brain ruptures or leaks.

In 2012, the beginnings of a three-tiered regionalized system of care were implemented. This involved the designation of certain hospitals as primary stroke centers (PSCs) and comprehensive stroke centers (CSCs), with CSCs providing the highest level of care.

Dr. Mullen and his colleagues decided to create virtual models in order to estimate what percentage of the population would have access to a comprehensive stroke center after selectively converting a number of primary stroke centers to facilities providing a higher level of care.

"In this report, we demonstrate how mathematical optimization modeling can inform the strategic development of the US network of stroke centers by simulating the conversion of PSCs into CSCs," the authors write. "This allows for virtual trials of competing system configurations in order to design a system that maximizes population access to care."

Reduced access to specialized stroke care could worsen pre-existing disparities in health

Data from 2010 was utilized, at which point there were 811 PSCs and no CSCs in the US. The researchers converted up to 20 PSCs in each state into CSCs and calculated how long it would take local populations to access these treatment facilities by ambulance or plane in optimum conditions.

After converting the PSCs to CSCs, the researchers found that only 63% would live within a 1-hour drive of a CSC, with an additional 23% within a 1-hour flight of one. 

"Even under optimal conditions, many people may not have rapid access to comprehensive stroke centers, and without oversight and population level planning, actual systems of care are likely to be substantially worse than these optimized models," says Dr. Mullen.

Levels of access to care also varied in different geographical areas. Worryingly, access to care was lowest in an area often referred to as the "Stroke Belt" - 11 states where stroke death rates are more than 10% higher than the national average, predominantly situated in the southeast of the US.

"Reduced access to specialized stroke care in these areas has the potential to worsen these disparities," says Dr. Mullen. "This emphasizes the need for oversight of developing systems of care."

The authors suggest the actual number of CSCs that will be established is likely to be much smaller than 20 per state, and that increasing the number of CSCs is not an ideal way to improve access for patients due to the high costs involved.

A number of limitations are acknowledged, such as using trauma data to calculate the amount of time taken to reach a hospital, and calculating population access to hospitals using where people live, rather than where strokes occur. However, the authors argue that the majority of strokes (over 70%) occur at home.

In a linked editorial, Dr. Adam G. Kelly and Dr. John Attia suggest that CSC status is likely to be determined more by financial motives, however, rather than a population health basis.

They write that timely accessibility of PSC services, either on-site or via telemedicine, should be the first priority in the organization of regional stroke care. Following this, "CSCs should be added in a coordinated, stepwise manner with regional needs - not hospital bottom lines - as the major determinant for new CSCs."

Source: www.medicalnewstoday.com

Topics: stroke, stroke center, health, nurse, nurses, doctors, health care, patients, hospitals, care

23 Things People Always Get Completely Wrong About Nurses

Posted by Erica Bettencourt

Fri, Feb 13, 2015 @ 12:11 PM

Alana Massey

 

We asked the BuzzFeed Community to tell us what the most common misconceptions about nurses are. They had a lot to say.

We asked the BuzzFeed Community to tell us what the most common misconceptions about nurses are. They had a lot to say.
Getty Images/iStockphoto

1. First of all, “Why didn’t you just become a doctor? You’re too smart to be a nurse” is a rude thing to say.

23 Things People Always Get Completely Wrong About Nurses
Wall Street Journal Live

Submitted by SadiaK.

2. And no, people can’t just apply for nursing licenses before being educated and rigorously trained.

23 Things People Always Get Completely Wrong About Nurses
20th Century Fox

Submitted by jennah4377addc7.

3. Because nursing is not about wiping butts all day.

Because nursing is not about wiping butts all day.
Shironosov / Getty Images/iStockphoto

Submitted by MariliseB

4. And nurses are not just there for their ability to “nurture” and “mother” patients; they’re there to use science and critical thinking to save lives.

23 Things People Always Get Completely Wrong About Nurses
PBS

Submitted by hellokitty914 and edwyer94.

5. Which is why it’s annoying when people think you’re always just following a doctor’s orders.

Which is why it's annoying when people think you're always just following a doctor's orders.
Getty Images/iStockphoto Dana Bartekoske

Submitted by oneloveyogi.

6. But you’d never know that from TV and movies, which almost never portray nurses accurately.

But you'd never know that from TV and movies, which almost never portray nurses accurately.
NBC / Getty Images

Submitted by angry penguin.

7. The reality is that doctors rely heavily on the knowledge and observations of nurses to make decisions about patient care.

23 Things People Always Get Completely Wrong About Nurses
NBC

Submitted by lexia49c9c42e3.

8. And it is often the nurses who make life and death decisions.

23 Things People Always Get Completely Wrong About Nurses

Submitted by andreae41060b2b6.

9. Nurses are actually more like a doctor-social worker-respiratory therapist-pharmacist-phlebotomist-physiotherapist-receptionist-X-ray technician-transporter-housekeeper-caregiver hybrid.

Nurses are actually more like a doctor-social worker-respiratory therapist-pharmacist-phlebotomist-physiotherapist-receptionist-X-ray technician-transporter-housekeeper-caregiver hybrid.
ThinkStock

Submitted by oneloveyogi.

10. Which is probably why they’re not actually wearing sexy nurse outfits over lingerie with stilettos on their feet.

Which is probably why they're not actually wearing sexy nurse outfits over lingerie with stilettos on their feet.

Submitted by sandrafromparis.

11. That might also be because a huge number of nurses are men.

That might also be because a huge number of nurses are men.

Submitted by preciouskittenn.

12. Who, by the way, are not all gay.

23 Things People Always Get Completely Wrong About Nurses
ABC

Submitted by richardd31.

So now that all that’s cleared up, there are a few more things that nurses don’t want or need to hear.

13. When nurses are “just taking blood pressure” they are simultaneously assessing a dozen things about a patient’s condition.

23 Things People Always Get Completely Wrong About Nurses

Submitted by shannooney.

14. It doesn’t help anyone to say that all nurses do is put on Band-Aids when they’re actually catching potentially fatal mistakes made by doctors who don’t know the patient as well.

It doesn't help anyone to say that all nurses do is put on Band-Aids when they're actually catching potentially fatal mistakes made by doctors who don't know the patient as well.
Fox

Submitted by betty.swiecka.

15. And when people assume a home health care nurse is there to give sponge baths and clean the house, it makes it harder for them to provide care.

And when people assume a home health care nurse is there to give sponge baths and clean the house, it makes it harder for them to provide care.
ThinkStock

Submitted by kimberly.riggs.18.

16. Saying nurses are so lucky to work three days a week ignores how much recovery time and rest is needed after long shifts and demanding work.

23 Things People Always Get Completely Wrong About Nurses
1492 Pictures

Submitted by lydia.maria.94.

17. Patients with the “I write your check” mentality that feel justified using nurses as servants make it harder for nurses to do their jobs.

23 Things People Always Get Completely Wrong About Nurses
Columbia Records / Via tumblr.com

Submitted by kelly.hilker.

18. That job is not being a personal drug dealer who is totally OK with going to jail just so a patient can get some OxyContin.

23 Things People Always Get Completely Wrong About Nurses
United Artists

Submitted by nic0lie0lie and cheries4218b4a82.

19. So if you come in and say you’re allergic to every drug except Dilaudid and that you needs lots and lotsof Dilaudid, the nurse is onto you, buddy.

So if you come in and say you're allergic to every drug except Dilaudid and that you needs lots and lots of Dilaudid, the nurse is onto you, buddy.
Warner Bros.

Submitted by cheries4218b4a82.

20. And when a nurse clearly knows the answer to your question and you say, “Can you ask the doctor?” you’re undermining their expertise and their profession.

23 Things People Always Get Completely Wrong About Nurses
United Artists

Submitted by lalroma.

21. But the great thing about nurses is that they don’t actually care all that much about all these misconceptions.

But the great thing about nurses is that they don't actually care all that much about all these misconceptions.
ThinkStock

Submitted by jonathanr49e5c50fe.

22. Because the thing they care more about than anything is saving your life.

Because the thing they care more about than anything is saving your life.
ThinkStock

Submitted by jonathanr49e5c50fe.

23. But for those of us who are annoyed on their behalves, we are just going to leave this here.

But for those of us who are annoyed on their behalves, we are just going to leave this here.
BuzzFeed

Submitted by ashleym45a8b720b.

Source: www.buzzfeed.com

Topics: nursing, health, nurse, nurses, doctors, medical, patients, physicians, hospitals

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