Pathologists' workload and patient safety

Pathologists play a pivotal role in providing good laboratory services. They are involved in the interpretation of laboratory and pathology results, and through their role as administrators, which include medical oversight, ensure proper functioning of the laboratory. An overworked pathologist can result in deficiencies in any of these roles and cause dysfunction of the laboratory and laboratory errors. Laboratory derived information comprises 70% of medical information necessary for patient management. Therefore, any laboratory error has a potential to adversely affect patient care and thus patient safety.     

Hospital mortality and optimality of nursing workload: A study on the predictive validity of the RAFAELA Nursing Intensity and Staffing system

BackgroundPatient classification systems have been developed to manage workloads by estimating the need for nursing resources through the identification and quantification of individual patients’ care needs. There is in use a diverse variety of patient classification systems. Most of them lack validity and reliability testing and evidence of the relationship to nursing outcomes.ObjectivePredictive validity of the RAFAELA system was tested by examining whether hospital mortality can be predicted by the optimality of nursing workload.MethodsIn this cross-sectional retrospective observational study, monthly mortality statistics and reports of daily registrations from the RAFAELA system were gathered from 34 inpatient units of two acute care hospitals in 2012 and 2013 (n = 732). The association of hospital mortality with the chosen predictors (hospital, average daily patient to nurse ratio, average daily nursing workload and average daily workload optimality) was examined by negative binomial regression analyses.ResultsCompared to the incidence rate of death in the months of overstaffing when average daily nursing workload was below the optimal level, the incidence rate was nearly fivefold when average daily nursing workload was at the optimal level (IRR 4.79, 95% CI 1.57–14.67, p = 0.006) and 13-fold in the months of understaffing when average daily nursing workload was above the optimal level (IRR 12.97, 95% CI 2.86–58.88, p = 0.001).ConclusionsHospital mortality can be predicted by the RAFAELA system. This study rendered additional confirmation for the predictive validity of this patient classification system. In future, larger studies with a wider variety of nurse sensitive outcomes and multiple risk adjustments are needed. Future research should also focus on other important criteria for an adequate nursing workforce management tool such as simplicity, efficiency and acceptability.     

Comparisons of self-ratings on managerial competencies,research capability,time management,executive power,workload and work stress among nurse administrators

Aims To assess the level of and the differences in managerial competencies, research capability, time management, executive power, workload and work-stress ratings among nurse administrators (NAs), and to determine the best predictors of managerial competencies for NAs. Background Although NAs require multifaceted managerial competencies, research related to NAs’ managerial competencies is limited. Method A cross-sectional survey was conducted with 330 NAs from 16 acute care hospitals. Managerial competencies were determined through a self-developed questionnaire. Data were collected in 2011. Results All NAs gave themselves the highest rating on integrity and the lowest on both financial/budgeting and business acumen. All scores for managerial competencies, research capability, time management and executive power showed a statistically significant correlation. The stepwise regression analysis revealed that age; having received NA training; having completed a nursing project independently; and scores for research capability, executive power and workload could explain 63.2% of the total variance in managerial competencies. Conclusion The present study provides recommendations for future administrative training programmes to increase NAs’ managerial competency in fulfilling their management roles and functions. Implications for Nursing Management The findings inform leaders of hospitals where NAs need to develop additional competencies concerning the type of training NAs need to function proficiently.     

Identifying Risk Factors of Upper Extremity Injuries in Collegiate Baseball Players: A Pilot Study

BackgroundRepetitive pitching places tremendous forces on the shoulder and elbow which can lead to upper extremity (UE) or lower extremity (LE) overuse injuries.PurposeThe purpose of this study was to evaluate pre-season physical measurements in collegiate baseball players and track in-season baseball throwing volume to determine which factors may predict throwing overuse injuries.Study DesignRetrospective Cohort study.MethodsBaseline preseason mobility, strength, endurance, and perception of function were measured in 17 collegiate baseball pitchers. Participants were then followed during the course of the season to collect rate of individual exposure, estimated pitch volume, and rating of perceived exertion in order to determine if changes in workload contributed to risk of injury using an Acute-to-Chronic Workload ratio (ACWR).ResultsParticipants developing an injury had greater shoulder internal rotator strength (p=0.04) and grip strength in a neutral position (p=0.03). A significant relationship was identified between ACWR and UE injuries (p <0.001). Athletes with an ACWR above or below 33% were 8.3 (CI₉₅ 1.8-54.1) times more likely to suffer a throwing overuse injury occurring to the upper or lower extremity in the subsequent week.ConclusionACWR change in a positive or negative direction by 33% was the primary predictor of subsequent injury. This finding may assist sports medicine clinicians by using this threshold when tracking pitch volume to ensure a safe progression in workload during a baseball season to reduce the risk of sustaining overuse upper or lower extremity injuries.Level of Evidence3b     

Patient SafetyNet for the Evaluation of Postoperative Respiratory Status by Nurses: A Presurvey and Postsurvey Study

PurposeThe purpose of this pre-post survey study was to assess the effect of the Patient SafetyNet system (Masimo Corp, Irvine, CA) on postoperative respiratory evaluation by nurses in general wards. Patient SafetyNet is a wireless monitoring system that evaluates respiratory rate and percutaneous oxygen saturation.DesignSurvey of nurses at a single medical center.MethodsStaff nurses (n = 75) were queried using a questionnaire asking about methods and problems of postoperative respiratory monitoring, usefulness of this system, and suggestions about suitable cases of this system.FindingsA total of 75 questionnaires were completed and returned. The nurses reported that central/remote (89.3%) or continuous (98.7%) monitoring was useful in the postquestionnaire. Moreover, the average frequency of clinical examination was reduced from 11.0 ± 2.3 to 5.1 ± 1.3. Using the Patient SafetyNet system led to a reported 61.3% reduction in nursing workload related to respiratory assessment postoperatively.ConclusionsContinuous monitoring of respiratory rate and percutaneous oxygen saturation after general anesthesia is recommended for patients' safety. Moreover, Patient SafetyNet can decrease the number of physical assessments of respiratory status for postoperative patients in the general wards, resulting in reduction of nurse's workload.