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revealed inconsistent findings on the effectiveness associated with interventions to reduce hospital length of stay (LOS) across all high-risk populations, underscoring important evidence gaps and the need for further research.

LOS is often used as a proxy for efficient hospital management, while reductions in LOS help improve bed turnover. This allows hospitals to match demand with capacity for elective and emergent admissions, intensive care unit (ICU) care, and interhospital transfers, researchers explained.

Numerous strategies to reduce LOS have been developed; however, a paucity of evidence exists when it comes to the effectiveness of interventions in unplanned hospitalizations, as opposed to elective admissions. This is especially true for populations at-risk for poor outcomes, including those with heart failure or older or medically complex patients.

To identify interventions aimed at reducing LOS among those at high risk of prolonged LOS, researchers conducted a systematic review of MEDLINE, PubMed, Embase, CINAHL, the Cochrane Library, and gray literature sources for studies published between 2010 to 2021. The Agency for Healthcare Research and Quality (AHRQ) Learning Health System panel commissioned this study.

A total of 19 systematic reviews were included, of which 10 included a mix of study designs, 8 included only randomized clinical trials, and 1 included only retrospective cohort studies. Eight strategies to reduce LOS in high-risk populations were assessed: discharge planning, geriatric assessment, medication management, clinical pathways, interdisciplinary or multidisciplinary care, case management, hospitalist services, and telehealth.

“Interventions were most frequently designed for older patients, often those who were frail (9 studies), or patients with heart failure,” authors wrote, while “there were notable evidence gaps, as there were no systematic reviews studying interventions for patients with socioeconomic risk.” These could have included patients with housing instability, social isolation, limited English proficiency, or other factors.

Reviews also did not assess LOS interventions among those with substance use disorder or common chronic diseases.

Although analyses did find that for patients with heart failure, clinical pathways and case management were linked with reduced LOS , due to the heterogeneity across studies included, authors underscored the important roles local contexts and resources may play in streamlining care.

In addition, they found that “for patients with medically complex conditions, discharge planning, medication management, and interdisciplinary care teams were associated with inconsistent outcomes (LOS, readmissions, mortality) across populations.”

Overall, this review showed no single intervention consistently reduced LOS in all high-risk populations.

“Future research assessing interventions for LOS reduction in high-risk populations or subpopulations should also consider implementation science measures to inform local adaption,” researchers concluded.

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Interventions aimed at reducing hospital length of stay (LOS) among at-risk patients lack consistent efficacy, according to a systematic review. 

Are Hospital-Led Interventions Reducing LOS for High-Risk Populations?

This past week, health organizations across the United States took the CDC’s 

—stating fully vaccinated individuals can shed their face coverings in all outdoor and most indoor spaces—in stride, with some lauding the confirmation of data on vaccine effectiveness in community settings, and others strongly cautioning against relaxed transmission protocols.

The new guidance was announced on May 13, and specifically stated mask-wearing is still required for crowded indoor settings like health care facilities and on forms of public transportation. In addition, “fully vaccinated people should continue to follow any applicable federal, state, local, tribal, or territorial laws, rules, and regulations,” the guidance reads, while those who have not received a vaccine should still comply with all transmission mitigation efforts in place before the update.

 immediately put the new guidance into effect, others pumped the brakes and took time to assess the new recommendations prior to instituting any sweeping changes.

For hospitals and health systems, caution continues to take precedence.

The Society for Healthcare Epidemiology of America (SHEA) emphasized the importance of continued transmission mitigation efforts especially in health care facilities as measures begin to relax.

“SHEA is excited that epidemiological data has confirmed vaccine effectiveness in community settings in recent months. We agree with the recommendations relaxing requirements for post-exposure, and post-travel, quarantine and testing for fully vaccinated individuals,” the organization said in a 

“However, SHEA strongly cautions against relaxing transmission mitigation efforts, including masking in communities with ongoing high rates of transmission and within healthcare settings.”

According to the CDC, all health care personnel should continue following infection prevention and control recommendations, including universal masking in health facilities, to protect themselves and others from infection.

“For health care personnel, it is often not known whether patients have been vaccinated when they first arrive in need of care, and we provide care for many highly immunocompromised patients who may remain vulnerable to COVID-19 even after vaccination,” SHEA’s statement reads.

“The potential for exposure to SARS-CoV-2 [the virus which causes COVID-19] is not limited to direct patient care interactions since transmission can also occur through unprotected exposures in common areas to asymptomatic or pre-symptomatic co-workers or visitors, whose vaccination status may also not be known,” they stated.

In a similar vein, America’s largest nurses’ union, National Nurses United, condemned the CDC’s announcement and called on it to revise its guidance, stating it would jeopardize the health of frontline workers and the general public, and disproportionately impact people of color, 

 reports. Less than 40% of the country’s population is currently fully vaccinated.

"It's important for patients to know that this new guidance doesn't apply to health care settings,” 

 John C. O’Horo, MD, MPH, a critical care and infectious disease specialist at the 

. "We ask our patients and visitors to continue to wear masks and socially distance to protect our patients. Also, state and local government may continue to require masking, particularly in places with increasing cases and relatively low COVID-19 vaccination rates.”

The Clinic is asking patients and visitors to continue to wear masks and socially distance even if they are fully vaccinated, in an effort to protect patients with weakened immune systems.

The American Hospital Association (AHA), a national organization representing all types of hospitals and health care networks, had 

 from the CDC following the announcement of relaxed guidelines.

Staff, patients, residents and visitors should continue to wear masks in health care facilities, the CDC told the AHA. The Center directed facilities to continue to refer to its infection prevention and 

 when it comes to source control and physical distancing.

“We appreciate the fact that fully vaccinated people are likely to have sufficient protection to be able to remove their masks now in many other settings, which will likely encourage others to consider getting their vaccination,” said Nancy Foster, AHA’s vice president of quality and patient safety policy.

“At the same time, we recognize that patients in hospitals may be immunocompromised and thus, less likely to be able to fight off the virus if they are exposed. This is why CDC’s directive stipulates that masks and other precautions should still be used in hospitals and other health care settings.”

Following an announcement from the CDC that fully vaccinated individuals no longer need to wear masks in all outdoor and most indoor spaces, health systems and hospitals responded by continuing to encourage caution. 

How Have Health Systems, Hospitals Responded to the CDC's Relaxation of Mask Guidance?

The COVID-19 pandemic has shined a light on the physical and emotional risks healthcare workers face in addition to systemic inequities present prior to the health crisis.

In an effort to spark a national movement for change, a coalition of health system CEOs has devised and signed a 

 setting new safety standards for these workers. The Coalition consists of 10 health system CEOs from across the country committed to improving safety, well-being and equity for all who work in the healthcare field.

The Declaration expands the definition of safety to cover psychological and emotional well-being, states equity and anti-racism are core components of safety, and works to ensure safety by eliminating physical and verbal workplace violence, according to a recent 

To learn more about the Coalition’s formation and how it devised these principles, 

 spoke with Johnese Spisso, MPA, president of UCLA Health and CEO of UCLA Hospital System. Spisso is a co-founder of the CEO Coalition and also co-wrote the Declaration. 

 Can you discuss how the CEO Coalition came together? Has the group worked on initiatives in the past?

Well, certainly this past year has brought a lot of new issues forward in healthcare and as our role as employers for an incredibly dedicated and talented workforce in healthcare. The coalition was founded by 10 healthcare system CEOs from across the country. The founding healthcare systems are diverse in both the background, the region, and types of hospitals they lead. It represents academic medical centers, not-for-profit hospitals, and safety net facilities. The group of CEOs convened because we all shared a common commitment that we really cared deeply about the safety of our team members and wanted to help spark a movement to set new standards of safety for the nation. We recognize that the COVID-19 pandemic was amplifying and bringing visibility to safety issues for team members. It also particularly amplified the physical and emotional risks healthcare team members face, as well as systemic inequities. It gave us an opportunity to look at issues through a new lens and think about how we could bring all of this talent and energy together and create a movement that would be impactful.

The Declaration of Principles covers some areas that were workplace concerns before the pandemic—such as protecting healthcare workers from violence. Is the Coalition drawing on efforts that were in motion before COVID-19 to improve the health and safety of the workforce?

The Declaration of Principles was drafted and refined based on feedback from in-depth interviews and convening with the executives and CEOs over the course of three months in the early part of 2021. We relied on research and strived to understand what core principles underline team members' ability to feel and be safe at work, even prior to the COVID-19 pandemic—because a lot of these issues were there in the past. The CEO Coalition, we have the goal of turning that Declaration of Principles into action by collaborating with healthcare institutions to conduct research and identify a set of evidence-based practices and measures that help support the Declaration of Principles. So, there's still a lot of work to do.

The Principles discuss investments in technology to reduce mental and physical burdens for staff. This sounds like it could include everything from reducing time in front of screens to equipment to help move/transfer larger patients. What is the breadth of investment envisioned?

Are best practices emerging to deal with staff burnout? If so, what are they?

Yes, and we certainly have seen burnout and fatigue throughout this pandemic, and it's come in waves. I think starting out, not only were our staff worried about their own safety, they were also worried about the safety of their families when they were coming into work, and then taking care of patients and going back home, particularly early in the pandemic when we didn't have all the information that we needed about COVID-19. We've tried to make sure we can continue to support their health and well-being and their families' health and well-being as we navigate through the pandemic and provide that direct frontline care. We've tried to do a lot of wraparound services to support the staff going the extra mile for us. I think a lot of institutions have done this with support for meals, support for groceries, support for housing, support for childcare. We've also, here at UCLA health, we've run a variety of virtual and online wellness programs like mindfulness meditation, yoga, as well as reaching out and calling our staff and seeing how they're doing, particularly those who were working in our COVID-19 units.

We had a recent commentary submitted that said one challenge of ensuring adequate staff is the lack of slots in nursing education programs. Has this problem come up at UCLA Health?

How will the Coalition measure the success of implementing the Principles?

That's a really important point. I think, as we bring forward new work to make sure it is having the impact that is desired, and I think that as we look at the CEO coalition, we'll be successful if healthcare team members' safety, as defined in the Declaration of Principles, is measurably improved within one to two years. Our vision is to build momentum by gaining the support of CEOs across the country to help demonstrate the importance of the issue, and specifically around those three pillars that we've defined for our healthcare system nationally. Those are the emotional and psychological safety, the health justice, and the physical safety. We also hope then, that we can use that work and those measured improvements to influence health policy, funding, and culture to create a safer experience for all who work in healthcare, and to keep our healthcare workforce on the job longer in their careers.

Chief Healthcare Executive™ discusses the CEO Coalition's new Declaration of Principles aimed at improving healthcare worker safety with Coalition co-founder and Declaration co-author Johnese Spisso, MPA.

Johnese Spisso on the CEO Coalition's Efforts to Improve Healthcare Worker Safety 

The majority of patients with COVID-19 who received home-based 

 did not require care escalation to a traditional hospital setting, according to study findings published in 

. This finding was consistent even if patients were older or obese.

As the COVID-19 pandemic forced health care systems to rapidly transform care to meet patient demand, Atrium Health implemented the Atrium Health Hospital at Home (AH-HaH) program early on to deliver home-based hospital-level care to increase the system’s bed capacity. The non-profit health system provides care to patents in North Carolina and Georgia.

To determine which AH-HaH patients were at increased risk for care escalation to traditional facilities, researchers conducted a retrospective cohort study of adults aged 18 and older who received treatment via the AH-HaH program between March and November 2020.

“Patients who the evaluating provider would otherwise have admitted to the brick-and-mortar facility who had safe living situations and clinical stability at admission” were eligible to participate in AH-HaH, authors wrote.

The program included telephonic access to nurses, daily in-home visits from paramedics, and virtual visits with a hospitalist, among other services. Baseline covariates and treatment information for each patient were collected via electronic health records.

Of the 391 eligible patients, 53% were female, 43% were White, and patients had a median age of 56 years. In addition, the median length of AH-HaH stay was three days. Analyses revealed:

84 patients (21%) were transferred to a brick-and-mortar facility within 14 days (median time to transfer, 2.2 days [interquartile range, 0.8 to 3.3 days])

Among hospital admissions, 33 required intensive care, 11 required mechanical ventilation, and there were 11 in-hospital deaths (causes included organ failure and shock)

Higher oxygen saturation was associated with decreased odds of transfer (odds ratio [OR], 0.87 [95% CI, 0.81-0.93]), whereas higher comorbidity burden was associated with increased odds of transfer (OR 1.12 [95% CI, 0.99-1.26])

Respiratory aberrations (such as low oxygen saturation, supplemental oxygen ≥3 L/min, and high respiratory rate) and tachycardia at enrollment were frequently observed among patients who required immediate care escalation

High-risk chronic conditions (such as hypertension and diabetes) were common among patients who required nonimmediate care escalation

Overall, approximately one in five patients were admitted within 14 days. Researchers hypothesized the lack of an independent association between older age or obesity and transfer may be due to providers being more cautious about enrolling these patients into the program.

“Although not statistically significant, race/ethnicity and area-level deprivation warrant additional research given established COVID-19 health disparities and possible bias due to home-based AH-HaH eligibility criteria,” they added.

The retrospective nature of the study, which was conducted at a single health system, marks a limitation, while its relatively small sample size could limit identification of significant risk factors for care escalation.

“Nevertheless, this study provides practical initial evidence to help inform patient selection guidelines as health systems and payers increasingly leverage hospital-at-home as a standard care delivery option,” researchers concluded.

A study identifies factors that put patients with COVID-19 receiving home-based care at risk for care escalation. 

Identifying Factors Linked to COVID-19 Care Escalation From In-Home to Hospital

In an effort to diversify its supply chain and support the local economy, Sentara Healthcare 

 the creation of a Supplier Diversity Executive Council. The not-for-profit system of 12 hospitals based in Norfolk, Virginia consists of over 300 sites of care and 28,000 employees.

Each year, the company typically spends around $2.4 billion on supply chain. But the pandemic caused the sum to spike to over $3 billion, while prices for personal protective equipment (PPE) 

. Under the new model, Sentara plans to grow partnerships with local and regional suppliers, in addition to companies owned by women, people of color and veterans.

Jennifer McPherren, vice president of supply chain, will chair the Council which will be made up of the health system’s director of diversity and inclusion, vice president of government relations, and representatives from the company’s real estate and construction divisions to help grow contracts with local companies.

The initiative began in 2017, when Sentara took a look at its existing vendors and began to stratify them and identify small businesses run by women and minorities (SWAM), explained Terrie Edwards, a corporate vice president at Sentara, in an interview with 

“In 2020, right before the pandemic, we decided that we were going to be very intentional about building our diversity base, not just ethnically, but by location, geographically, and types of businesses that align more closely with SWAM,” Edwards said.

When the COVID-19 pandemic squeezed the global supply chain and created mass PPE shortages, Sentara was able to contract with two local companies to help offset the shortage.

“There was a small business in the Virginia Beach market that was in the process of learning to make procedural masks, and we needed procedural masks, and they got the pricing of those procedural masks pretty competitive. So, we switched from the national vendor ordering the procedural masks overseas to this local vendor, who has become a partner with ours,” Edwards explained. Switching to a local vendor, the company was able to save money by cutting down on transportation costs.

Sentara currently gets vendors through its national group purchasing organization or through local and regional contracts, while a new position at Sentara will be charged with broadening the overall supplier base. Through this initiative, the company hopes to ensure enough supplies are on hand or delivered when disruptions like COVID-19 or the 

Citing the effects of Hurricane Maria on the pharmaceutical industry in 

 in 2017, Edwards emphasized the importance of diverse supply chains and alternative product streams.

“What you realize is when you become so dependent on another country, you really are at their mercy. If they dry up, you have no alternative,” Edwards said.

The company has also increased its identification and tracking of tier 2 vendors, or vendors subcontracted by those with whom Sentara contracts. “We had one project that was an emergency room project at one of our hospitals…And when we broke it down, it was about 50% of the total subcontractors, or tier 2, were minority businesses or small businesses. That was pretty exciting to see that our contractors are now moving in that direction as well.”

As part of its 3-year diversification goal, small suppliers will receive quarterly education sessions through Sentara in an effort to better respond to proposal requests and thrive as long-term partners. This way, Sentara can understand what products businesses might have and help those who qualify become certified SWAM vendors.

Because the transition offers a much richer supply chain, other health systems are interested in Sentara’s initiative, Edwards said. “I think all businesses are realizing that that's value added. And if you can infuse money in your local economy, then that helps everyone, especially at a time like this.”

Overall, the system initiative strives to look at its 

 in a holistic manner. By infusing money into the local economy, it opens a window for more jobs to be created and the potential for employer-provided health benefits, ultimately spreading equity within the community. The full diversity and inclusion plan encompasses employees, community commitments and relationships with business partners.

“What we hope to do with our diversity is really lessen our dependency on a few key vendors, invest in our local community and create jobs by supporting local businesses,” Edwards said.

Sentara Healthcare announces the formation of its Supplier Diversity Executive Council.

Sentara Healthcare Initiative Aims to Boost Supply Chain Diversity 

 survey conducted in December of 2020 found nearly three-quarters of Americans (72%) prefer their doctor to use a mobile prescribing tool when away from the office. 

 also revealed 53% of respondents said some of their prescriptions are still sent to pharmacies via phone, fax or paper. This can lead to potential days-long delays in receiving even urgently needed medications.

A total of 1,004 U.S. consumers over the age of 18 took part in the national online survey. Results indicated four in 10 Americans have had to wait at least over night or a weekend for their doctor to return to the office and send a prescription, while over half of patients surveyed reported waiting for prescriptions for controlled substances. In 2020, over 4.5 billion prescriptions were filled in the United States.

Waiting is not an option for some patients in need of acute care and can lead to unnecessary emergency department visits. Although most e-prescribing takes place in a physician’s electronic health record (EHR) system, for those out of the office, mobile e-prescribing with a smartphone can offer real time help for patients.

When it comes to prescribing controlled substances, 72% of those surveyed said their doctors still use paper prescriptions. This measure was required until 2010, but since then, DrFirst has developed technology for electronic prescribing for controlled substances (EPCS). Many states currently mandate EPCS and it will be required by the federal government in 2022.

According to the organization, EPCS can help prevent opioid abuse, avoid prescription fraud, and improve prescribing safety, efficiency and patient satisfaction.

“At this point, there is simply no reason for physicians to continue keeping spare prescription pads around the office, and especially not using paper prescriptions for controlled substances,” said Colin Banas, MD, the chief medical officer at DrFirst.

Some doctors may be adhering to older methods because their current system does not include EPCS functionality, or they don’t have access to their practice’s system outside of the office.

“E-prescribing is safer for several reasons, including automated interaction and allergy alerts, access to patients’ medication history, and artificial intelligence that can help avoid keyboard errors,” Banas said.

Americans want their providers to use electronic methods to prescribe medications, according to new survey findings. 

Survey Underscores Need for Efficient Prescribing Modalities 

 from CMS would increase Medicare inpatient prospective payment system (IPPS) rates by a net 2.8% during the 2022 fiscal year (FY), compared with FY 2021, the 

 reports. It would also repeal requirements to report certain payer-negotiated rates and change the Graduate Medical Education (GME) program and related payments, quality measurement and value programs.

The rule would apply to hospitals that meaningfully use electronic health records (EHR) and submit quality measure data.

CMS hopes to rebase and revise the hospital market baskets for acute care hospitals, update the labor-related share, and provide the market basket update to the rate-of-increase limits for some hospitals excluded from the IPPS.

Last year, the Center finalized a requirement that hospitals report median payer-specific negotiated rates for inpatient services for Medicare Advantage organizations. The new rule aims to repeal that requirement while also repealing the market-based Medicare Severity Diagnosis Related Group methodology it planned to implement in FY 2024. As an alternative, CMS would continue to use existing cost-based methodology and FY 2019 data to approximate expected FY 2022 inpatient hospital utilization.

“Based on our initial review, we are very pleased CMS is proposing to repeal the requirement that hospitals and health systems disclose privately negotiated contract terms with payers on the Medicare cost report,” said AHA executive vice president Tom Nickels.

“We have long said that privately negotiated rates take into account any number of unique circumstances between a private payer and a hospital and their disclosure will not further CMS's goal of paying market rates that reflect the cost of delivering care. We once again urge the agency to focus on transparency efforts that help patients access their specific financial information based on their coverage and care.”

The rule also aims to implement provisions of the Consolidated Appropriations Act, including distributing 1,000 Medicare-funded medical residency positions and of the Promoting Rural Hospital GME Funding Opportunity, allowing certain rural training hospitals to receive a cap increase for GME.

Furthermore, “we are proposing to extend New COVID-19 Treatments Add-on Payment (NCTAP) for certain eligible products through the end of the fiscal year in which the public health emergency ends and to discontinue the NCTAP for discharges on or after October 1, 2021, for a product that is approved for new technology add-on payments beginning FY 2022,” the rule reads.

Estimated and newly established performance standards for the Hospital Value-Based Purchasing Program will be provided as well as updated policies for the Hospital Readmissions Reduction Program, among others.

Medicare organ acquisition payment policies relative to organ procurement organizations, transplant hospitals and donor community hospitals will also be changed and clarified.

The rule further proposes to amend the Medicare Shared Savings Program regulations so eligible accountable care organizations can maintain their current level of participations for performance year 2022.

“We are heartened CMS recognizes the COVID-19 pandemic has resulted in non-representative performance in its hospital quality measurement and value programs, requiring temporary policy adjustments,” Nickels said. “We will work with the agency to ensure its finalized policies assess hospitals in a fair and transparent manner.”

Comments on the proposed rule will be accepted through June 28.

A new rule proposed by CMS aims to increase Medicare inpatient prospective payment system rates.

CMS Rule Proposed for Hospital IPPS

, the American College of Physicians (ACP) called for improvements in the existing health information privacy framework and for expansion of similar privacy guardrails to entities not governed by current laws and regulations.

As the prevalence of telehealth continues to grow in the United States and as technology advancements increase in the field, the number of digital interactions and personal health information generated and collected has kept pace with expansion.

However, the risk of data system breaches and commercialization of data threaten to derail these advances and those goals laid out in the Health Insurance Portability and Accountability Act (HIPAA), enacted in 1996.

According to authors, an expanded privacy framework should ideally “protect personal health information from unauthorized, discriminatory, deceptive, or harmful uses and align with the principles of medical ethics, respect individual rights, and support the culture of trust necessary to maintain and improve care delivery.”

The absence of a single, comprehensive framework for personal health information privacy and uses in the United States complicates this effort and compounds the risk of data misuse.

Although HIPAA is still in place, the act does not apply to entities collecting personal health information like mobile health applications and wearable medical devices. Furthermore, neither the FDA nor the Federal Trade Commission (FTC) regulate the use and exchange of information collected by these devices.

When devising an improved framework, parties should aim to balance individual interests with potential uses of health information to improve care. “Persons need to feel confident that they can receive needed health care and participate in the digital health ecosystem without inappropriate disclosure or use of their information,” researchers wrote, “lest distrust in physicians and the health care system as a whole lead to withholding of pertinent health information with potentially negative clinical consequences.”

To help guide new recommendations on this topic, the Medical Informatics Committee and the Ethics, Professionalism and Human Rights Committee of ACP reviewed available studies, reports, statutes, regulations and other sources on the matter.

The Committees devised six guiding principles on health information privacy, protection and use. They state:

Protecting privacy and security of personal health information, while providing individual rights to that information, is essential to foster trust, maintain ethical standards, and promote safe delivery of care.

Increased transparency, public understanding, and improved models of consent about collection, exchange and use of data within existing rules and those outside these rules should be implemented.

Confidentiality is a fundamental aspect of medical care, and providers have an obligation to adhere to privacy and security protocols.

Digital technologies should incorporate privacy and security principles and consistent data standards within their designs.

Enforcement should ensure all entities not covered by HIPAA that interact with personal health data are held accountable for confidentiality, privacy, and security of information.

New approaches to privacy and security should be tested before implementation and be reevaluated regularly to assess effects in real-world health settings.

Authors also called for federal legislation on protecting personal health information and that an industry-wide consensus is reached on the matter. As interoperability improves and more access to this data is gained, awareness of implications and new individual responsibilities need to play a role in this undertaking.

“Patients must be able to trust in the power of digital health technology and can only truly do so if they feel their private information is being safeguarded on all levels,” 

 Jacqueline W. Fincher, MD, MACP, the president of ACP. “It is our hope as frontline physicians who use these technologies every day, that the implementation of the recommendations offered in this paper will help ensure more comprehensive health information privacy and security protections.”

The American College of Physicians outlined guiding principles for future improvements in personal health data collection and use. 

Safeguarding Personal Data: ACP Offers Guiding Principles for Future Privacy Frameworks 

 conducted by Avant Healthcare Professionals on the state of 

 in 2021 compared data from 2019 and 2020 to explore shifts in nursing trends in the United States.

In part due to older nurses retiring, current registered nurses (RNs) burning out, educational resources for new nurses decreasing, and turnover rates increasing, nursing shortages are expected to grow in the years to come. However, an aging US population, the opioid crisis, lack of frontline workers and COVID-19 have all contributed to the rising demand for health care professionals, researchers wrote.

To better understand this imbalance, a survey was sent to Chief Executive Officers (CEOs), Chief Nursing Officers (CNOs), and Human Resources (HR) executives at various health settings across the country between January and February 2021.

Over 100 responses from critical access hospitals, state facilities, and other settings were included in the analysis. Although executives reported they rely on new graduates (71%), internal recruitment (45%) and external advertising to fill nurse openings, an average of one in five nurses will leave their first job within 12 months of starting, amounting to $7 million in hospital losses annually.

Survey results show 36% of respondents anticipate more than 25 RN job openings in 2021 compared with 17% in 2020, while 21% of respondents said they had over 50 openings, and 11% reported over 100 vacancies in 2021. Eighty percent of those surveyed reported losing current RNs to other hospitals for travel assignments.

Compounding the issue, nursing school enrollment is not keeping pace with projected demand and many hospitals are turning to monetary incentives to fill RN openings. Nearly 30% of respondents plan to improve pay packages to meet the shortage and nearly 40% said they offer sign-on bonuses. Of those surveyed, 81% believe volume of nursing school graduates will decrease due to the COVID-19 pandemic.

Respondents indicated medical-surgical, emergency room (ER), intensive care unit (ICU), and operating room (OR) specialties need nurses the most while over 90% said they currently employ traveling RNs to assist with influxes of COVID-19 patients. Survey results show an increase in pediatric nurse demand from 8% in 2020 to 13% in 2021.

Demand for traveling nurses also led to increased rates, and “a majority of respondents said they were spending between $100-$150 an hour for travel RNs.” Because of this, some health care systems struggled to keep nurses who instead sought higher-paying travel assignments.

“Hospitals were not only paying double the rates for travel nurses but also increased RN staff pay and offered incentives to keep staff at their facility,” authors wrote, “58% of respondents said they offered staff a COVID-hazard pay increase while 56% offered bonuses.”

More cost-effective ways to combat increases in staffing costs could include tuition reimbursement, individuals seeking temporary to permanent work, and employing international nurses who are contracted for two to three years. In comparison, travel nurses typically are employed for 13-week commitments.

Suspension of routine operating room procedures to conserve capacity, supplies, and staff for COVID-19 patients also resulted in hospitals furloughing OR staff, while 20% of respondents reported they have not been able to bring back 100% of their OR RNs. Fifty-Five percent of respondents reported cross training these staff in different departments.

When it comes to the COVID-19 pandemic specifically, responses revealed:

70% of respondents reported that they lost anywhere between 5%-30% of their staff due to COVID-19 while 49% of respondents said they lost 5%-15% of their staff to higher-paying travel assignments.

70% of respondents said COVID-19 has impacted their onboarding capabilities, while 63% of respondents said COVID-19 increased new graduates’ orientation timeline.

Some respondents said nurses were coming in with less clinical experience, they had orientation online rather than in person, they had to rush the orientation process and some even had to cancel their RN nurse residency program.

33% of respondents believe COVID-19 will have a long-term impact on the health and well-being of their staff over the coming months and there will be a great loss of bedside nurses to other careers in the years to come.

Although data projects two million new nurses will join the workforce in the future, another one million will be lost, researchers said. “There is now more than ever, a sense of urgency to fill the gaps of the amount of experienced, tenured nurses who will retire in the coming years,” they concluded.

Survey responses from health care facilities across the country outline current nurse shortages and foretell of future vacancies. 

Health Care Facilities Report Significant Nurse Shortages, Concern About Future Vacancies

Results of a longitudinal survey study offer new insights on how patient-reported data could be collected and used in hospital quality improvement. 

, also open the debate about the use of real-time focused data when capturing vulnerable 

“Patient-reported data (satisfaction, preferences, outcomes and experience) have been increasingly studied with the aim of providing excellent patient-centered care,” researchers wrote. “In particular, the collection of patient experience data is emerging as an increasingly key component in assessing the quality of delivered health services.”

Patient experience data collected throughout different points in a patient’s stay at a hospital (i.e. patient journey) could help discern whether there are discontinuities within units and between different units. In the absence of a complete view of the whole process, inter- and cross-organizational gaps like obstructed data flow and lack of service synchronization can occur, authors explained.

In order to explore which data collected from patients could be useful in improving the patient journey and to analyze whether gathering timely patient experience data can capture areas for improvement, patients in the orthopedics department at a 250-bed Italian university hospital participated in a longitudinal survey study.

As the unit of analysis was the patient’s journey from first outpatient visit to hospital discharge, all individuals who underwent major or minor orthopedic surgery between January and February 2019 were considered for inclusion. Participants received two different questionnaires assessing patient-reported outcomes, patient-reported experience, patient-reported satisfaction, and patient-reported preferences at two different stages of the hospital patient journey: at the time of admission before surgery and at discharge.

A total of 254 participants completed the pencil and paper questionnaires, and more than 80% were older than 50 years. Knee replacement and hip replacement were the most common major surgical operations completed.

Overall, analyses of the patient-reported data showed “greater or less negative satisfaction may not reveal pathology-related needs, but patient experience data can detect important areas of improvement along the hospital journey,” authors wrote.

“As clinical conditions and the context of care change rapidly within a single hospital stay for surgery, collecting data at two different moments of the patient journey enables researchers to capture areas of potential improvement in the patient journey that are linked to the context, clinical conditions and emotions experienced by the patient,” they added.

Results revealed the five most important aspects for a good hospital journal experience, including:

Receive the best treatment for the related health conditions

Have clear instructions on how to prepare for surgery (therapy, fasting, surgery aids)

Have clear instructions on how to check in at the hospital

Have clear indications on the treatment pathway I will also have to take

Receive explanations from staff in case of waiting

In comparison, the least important aspects included:

Have explanations and understand everything that happens to me

Be involved in all decisions concerning my care

Feel comfortable in the environments where I have to be

Wait as little time as possible for a visit or for assistance

Have a room where I am not disturbed and with hotel services (TV, landline, etc.)

“By timely and simultaneously gathering preferences, satisfaction, outcomes and experience data, it is possible to have a complete picture of the hospital patient journey,” researchers wrote. Furthermore, results show how “at the beginning of the journey, patients might consider an issue as not critical, but while living the hospital experience, it becomes important.”

Authors concluded results emphasize that personalized medicine should not only refer to targeted therapy but requires management teams to be able to customize the patient’s journey and identify different patient profiles.

As the study was conducted at a single center, results cannot be generalized, marking a limitation to the study. Because the orthopedic surgical journey is relatively shorted compared with the oncological one, for example, this aspect could have influenced the results and methodology should be tested on difference clinical pathways. Futures studies should also explore the impact of the patient-health care staff relationship in the hospital journey experience.

Responses collected from longitudinal surveys show how patient-reported data can help improve hospital quality. 