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BACKGROUND Most hospitals in the United States are reimbursed for colectomy via a bundled payment based on the diagnosis-related group assigned. Enhanced recovery after surgery programs have been shown to improve the value of colorectal surgery, but little is known about the granular financial tradeoffs required at individual hospitals. OBJECTIVE The purpose of this study is to analyze the index-hospitalization impact on specific cost centers associated with enhanced recovery after surgery implementation for diagnosis-related groups commonly assigned to patients undergoing colon resections. DESIGN We performed a single-institution retrospective, nonrandomized, preintervention (2013-2014) and postintervention (2015-2017) analysis of hospital costs. SETTING This study was conducted at an academic medical center. PATIENTS A total of 1297 patients with diagnosis-related group 330 (colectomy with complications/comorbidities) and 331 (colectomy without complications/comorbidities) were selected. MAIN OUTCOME MEASURES The primary outcome was total index-hospitalization cost. Secondary outcomes included specific cost center expenses. RESULTS Total median cost for diagnosis-related group 330 in the pre-enhanced recovery after surgery group was $24,111 ($19,285-$28,658) compared to $21,896 ($17,477-$29,179) in the enhanced recovery after surgery group, p = 0.01. Total median cost for diagnosis-related group 331 in the pre-enhanced recovery after surgery group was $19,268 ($17,286-$21,858) compared to $18,444 ($15,506-$22,847) in the enhanced recovery after surgery group, p = 0.22. When assessing cost changes after enhanced recovery after surgery implementation for diagnosis-related group 330, operating room costs increased (p = 0.90), nursing costs decreased (p = 0.02), anesthesia costs increased (p = 0.20), and pharmacy costs increased (p = 0.08). For diagnosis-related group 331, operating room costs increased (p = 0.001), nursing costs decreased (p < 0.001), anesthesia costs increased (p = 0.03), and pharmacy costs increased (p = 0.001). LIMITATIONS This is a single-center study with a pre- and postintervention design. CONCLUSIONS The returns on investment at the hospital level for enhanced recovery after surgery implementations in colorectal surgery result largely from cost savings associated with decreased nursing expenses. These savings likely offset increased spending on operating room supplies, anesthesia, and medications. See Video Abstract at http://links.lww.com/DCR/B204. IMPACTO DE LA IMPLEMENTACION DEL PROTOCOLO DE RECUPERACION MEJORADA DESPUES DE CIRUGIA EN EL COSTO DE LA HOSPITALIZACION INDICE EN CENTROS ESPECIFICOS: La mayoria de los hospitales en los Estados Unidos son reembolsados por la colectomia a traves de un paquete de pago basado en el grupo de diagnostico asignado. Se ha demostrado que los programas de recuperacion despues de la cirugia mejoran el valor de la cirugia colorrectal, pero se sabe poco sobre las compensaciones financieras granulares que se requieren en los hospitales individuales.El objetivo de este estudio es analizar el impacto del indice de hospitalizacion en centros de costos especificos asociados con la implementacion de RMDC para grupos relacionados con el diagnostico comunmente asignados a pacientes que se someten a resecciones de colon.Realizamos un analisis retrospectivo, no aleatorio, previo (2013-2014) y posterior a la intervencion (2015-2017) de los costos hospitalarios de una sola institucion.Centro medico academico.Un total de 1. 297 pacientes con diagnostico relacionado con el grupo 330 (colectomia con complicaciones/comorbilidades) y 331 (colectomia sin complicaciones/comorbilidades).El resultado primario fue el indice total de costos de hospitalizacion. Los resultados secundarios incluyeron gastos especificos del centro de costos.El costo medio total para el grupo relacionado con el diagnostico de 330 en el grupo de recuperacion pre-mejorada despues de la cirugia fue de $24,111 ($19,285- $28,658) en comparacion con $21,896 ($17,477- $29,179) en el grupo de recuperacion mejorada despues de la cirugia, p = 0.01. El costo medio total para DRG 331 en el grupo de recuperacion pre-mejorada despues de la cirugia fue de $19,268 ($17,286- $21,858) en comparacion con $18,444 ($15,506-$22,847) en el grupo de recuperacion mejorada despues de la cirugia, p = 0.22. Al evaluar los cambios en los costos despues de una recuperacion mejorada despues de la implementacion de la cirugia para el grupo 330 relacionado con el diagnostico, los costos de la sala de operaciones aumentaron (p = 0.90), los costos de enfermeria disminuyeron (p = 0.02) los costos de anestesia aumentaron (p = 0.20) y los costos de farmacia aumentaron (p = 0.08). Para el grupo 331 relacionado con el diagnostico, los costos de la sala de operaciones aumentaron (p = 0.001), los costos de enfermeria disminuyeron (p < 0.001) los costos de anestesia aumentaron (p = 0.03) y los costos de farmacia aumentaron (p = 0.001).Este es un estudio de un solo centro con un diseno previo y posterior a la intervencion.El retorno de la inversion a nivel hospitalario para una recuperacion mejorada despues de la implementacion de la cirugia en la cirugia colorrectal se debe en gran parte al ahorro de costos asociado con la disminucion de los gastos de enfermeria. Es probable que estos ahorros compensen el aumento de los gastos en suministros de quirofano, anestesia y medicamentos. Consulte Video Resumen en http://links.lww.com/DCR/B204. (Traduccion-Dr. Gonzalo Hagerman).

Objective: Hospital-acquired pressure ulcers (PU) have a substantial negative impact on patients and continue to impose a cost burden on hospital providers. Since the incidence of fragility fracture is growing, driven by the increase in the older population, it is expected that the overall incidence of associated complications will also increase accordingly. The aim of this economic evaluation was to determine whether the use of a multilayer, silicone-adhesive polyurethane foam dressing (ALLEVYN LIFE, Smith & Nephew, UK) alongside standard prevention (SP) for the prevention of PUs in older patients with hip fractures is a cost-effective strategy, compared with SP alone. Method: A decision-analytic model was constructed to determine the incremental cost and effectiveness of the foam dressing strategy from the perspectives of the Italian and US hospital systems. We also performed one-way and probabilistic sensitivity analyses. Results: The foam dressing intervention was found to be cost saving and more effective than SP in both Italy and the US. Switching to foam dressing and standard prevention would result in an expected cost saving of €733 per patient in Italy and $840 per patient in the US, reducing the per-patient cost of treating PUs by 37-69% and 36–68%, respectively. The one-way and probabilistic sensitivity analyses demonstrate that the strategy remains dominant over a range of values of the input variables. Conclusion: The foam dressing intervention is likely to be a cost-effective strategy compared with standard prevention alone.

The need for home care services is expanding around the world with increased attention to the resources required to produce them. To assist decision making, there is a need to assess the cost-effectiveness of alternative programs within home care. Electronic searches were performed in five databases (before February 2020) identifying 3292 potentially relevant studies that assessed new or enhanced home care interventions compared with usual care for adults with an accompanying economic evaluation. From these, 133 articles were selected for full-text screening; 17 met the inclusion criteria and were analyzed. Six main areas of research were identified including the following: alternative nursing care (n = 4), interdisciplinary care coordination (n = 4), fall prevention (n = 4), telemedicine/remote monitoring (n = 2), restorative/reablement care (n = 2), and one multifactorial undernutrition intervention study. Risk of bias was found to be high/weak (n = 7) or have some concerns/moderate (n = 6) rating, in addition to inconsistent reporting of important information required for economic evaluations. Both health and cost outcomes had mixed results. Cost-effective interventions were found in two areas including alternative nursing care and reablement/restorative care. Clinicians and decision makers are encouraged to carefully evaluate the quality of the studies because of issues with risk of bias and incomplete reporting of economic outcomes.

Background and Purpose: Delirium is a common severe complication of stroke. We aimed to determine the cost-of-illness and risk factors of poststroke delirium (PSD). Methods: This prospective single-center study included n=567 patients with acute stroke from a hospital-wide delirium cohort study and the Swiss Stroke Registry in 2014. Delirium was determined by Delirium Observation Screening Scale or Intensive Care Delirium Screening Checklist 3 times daily during the first 3 days of admission. Costs reflected the case-mix index and diagnosis-related groups from 2014 and were divided into nursing, physician, and total costs. Factors associated with PSD were assessed with multiple regression analysis. Partial correlations and quantile regression were performed to assess costs and other factors associated with PSD. Results: The incidence of PSD was 39.0% (221/567). Patients with delirium were older than non-PSD (median 76 versus 70 years; P P P =0.002). Moderate to severe stroke (National Institutes of Health Stroke Scale score 16–20) was the most relevant precipitating factor (odds ratio, 36.10 [8.15–159.79], P P P P P P Conclusions: PSD was associated with greater stroke severity, prolonged hospitalization, and increased nursing and total costs. In patients with severe stroke, dementia, or seizures, PSD is anticipated, and additional costs are associated with hospitalization.

To explore the relationship between ethical climate (EC) and nurses' service behaviours (SB) and examine the moderating effect of nurses' employment type.As most public hospitals in China implement the "dual-track system" of nurses' employment, the two different types of nurses, contract-employed nurses and state-employed nurses, receive the different pay for the same work, which results in they providing different SB. It has become critical for hospital administrators and nursing managers to understand better the state of two groups of nurses and to find an effective method to improve the service level of the nursing workforce.Stepwise multiple regression analyses of survey data collected in June and July 2017 from Chinese nurses employed in three tertiary hospitals.Chinese nurses (298 of 350 [85.1%]) were interviewed using the Ethical Climate Scale and Nurses' Service Behaviour Scale. Data were analysed statistically using descriptive statistics, confirmatory factor analysis, correlation coefficients (Pearson), two-tailed t-test and stepwise multiple regression analyses were conducted to test the proposed hypotheses. Data were analysed using SPSS and AMOS.There were statistically significant correlations between EC and nurses' extra-role service behaviour (ERSB) and overall service behaviour and nurses' employment type moderated the proposed relationships.Healthcare institutions should pay more attention to cultivate EC and implement new incentive mechanism to better stimulate nurses to provide ERSB.目的: 探讨组织伦理氛围(EC)与护士服务行为(SB)之间的关系,评估护士雇佣类型的调节作用。 背景: 随着我国大多数公立医院实行护士雇佣“双轨制”,因此两种不同类型的护士,即合同聘用护士和国家雇佣护士,在同一项工作中所获得的报酬却不同,这导致他们提供不同种类的服务行为。如何更好地了解两种雇佣类型护士的状况,找到提高护理队伍服务水平的有效方法,已成为医院管理人员和护理管理人员需考虑的重要问题。 设计: 对2017年6月和7月三级医院聘用的中国护士的调查数据进行逐步多元回归分析。 方法: 采用组织伦理氛围量表和护士服务行为量表对350名中国护士中的298名(85.1%)进行调查。采用描述性统计、验证性因素分析、相关系数(Pearson)、双尾t检验对数据进行统计分析,并通过逐步多元回归分析检验所提出的假设。使用SPSS和AMOS来分析数据。 结果: EC与护士的角色外服务行为(ERSB)与整体服务行为之间存在显著的统计学关联,而护士的雇佣类型可缓和以上关系。 结论: 医疗机构应重视培养组织伦理氛围,实施新型激励机制,从而更好地鼓励护士提供角色外服务行为。.

Background Traditional prenatal care includes up to 13 in person office visits, and the cost of this care is not well-described. Alternative models are being explored to better meet the needs of patients and providers. OB Nest is a telemedicine-enhanced program with a reduced frequency of in-person prenatal visits. The cost implications of connected care services added to prenatal care packages are unclear. Methods Using data from the OB Nest randomized, controlled trial we analyzed the provider and staff time associated with prenatal care in the traditional and OB Nest models. Fewer visits were required for OB Nest, but given the compensatory increase in connected care activity and supplies, the actual cost difference is not known. Nursing and provider staff time was prospectively recorded for all patients enrolled in the OB Nest clinical trial. Published 2015 national wages for healthcare workers were used to calculate the actual labor cost of providing either traditional or OB Nest prenatal care in 2015 US dollars. Overhead expenses and opportunity costs were not considered. Results Total provider cost was decreased caring for the OB Nest participants, but nursing cost was increased. OB Nest care required an average of 160.8 (+/− 45.0) minutes provider time and 237 (+/− 25.1) minutes nursing time, compared to 215.0 (+/− 71.6) and 99.6 (+/− 29.7) minutes for traditional prenatal care (P Conclusions In this trial, labor cost for OB Nest prenatal care was 34% higher than for traditional prenatal care. The increased cost is largely attributable to additional nursing connected care time, and in some practice settings may be offset by decreased overhead costs and increased provider billing opportunities. Future efforts will be focused on development of digital solutions for some routine nursing tasks to decrease the overall cost of the model. Trial registrations ClinicalTrials.gov Identifier: NCT02082275.

Background In the last decade, there is an increasing focus on detecting and compiling lists of low-value nursing procedures. However, less is known about effective de-implementation strategies for these procedures. Therefore, the aim of this systematic review was to summarize the evidence of effective strategies to de-implement low-value nursing procedures. Methods PubMed, Embase, Emcare, CINAHL, PsycINFO, Cochrane Central Register of Controlled Trials, Web of Science, and Google Scholar were searched till January 2020. Additionally, reference lists and citations of the included studies were searched. Studies were included that described de-implementation of low-value nursing procedures, i.e., procedures, test, or drug orders by nurses or nurse practitioners. PRISMA guideline was followed, and the ‘Cochrane Effective Practice and Organisation of Care’ (EPOC) taxonomy was used to categorize de-implementation strategies. A meta-analysis was performed for the volume of low-value nursing procedures in controlled studies, and Mantel–Haenszel risk ratios (95% CI) were calculated using a random effects model. Results Twenty-seven studies were included in this review. Studies used a (cluster) randomized design (n = 10), controlled before-after design (n = 5), and an uncontrolled before-after design (n = 12). Low-value nursing procedures performed by nurses and/or nurse specialists that were found in this study were restraint use (n = 20), inappropriate antibiotic prescribing (n = 3), indwelling or unnecessary urinary catheters use (n = 2), ordering unnecessary liver function tests (n = 1), and unnecessary antipsychotic prescribing (n = 1). Fourteen studies showed a significant reduction in low-value nursing procedures. Thirteen of these 14 studies included an educational component within their de-implementation strategy. Twelve controlled studies were included in the meta-analysis. Subgroup analyses for study design showed no statistically significant subgroup effect for the volume of low-value nursing procedures (p = 0.20). Conclusions The majority of the studies with a positive significant effect used a de-implementation strategy with an educational component. Unfortunately, no conclusions can be drawn about which strategy is most effective for reducing low-value nursing care due to a high level of heterogeneity and a lack of studies. We recommend that future studies better report the effects of de-implementation strategies and perform a process evaluation to determine to which extent the strategy has been used. Trial registration The review is registered in Prospero (CRD42018105100).

The study presents the current profile of Peruvian nursing, its professional construction and its dilemmas, emphasizing its socio-cultural features. To this end, an extensive literature was reviewed, interviewing nurses in key positions and analyzing secondary source data. This study keeps its distance from other studies on health care professions as a workforce, to analyze the low social legitimacy of the nursing profession despite being the great operator of health care services in Peru. This resulting psychological overload, additionally to the work overload is reflected in job dissatisfaction, stress, burnout, intention of changing careers, and a strong desire to migrate. As a result, Peruvian nursing has opted for three alternatives: a) resilience, which means to adapt to this unfavorable situation; b) abandoning the profession, or leaving the country; and c) reaction, which gathers all manifestations of the profession against abandonment, informality, and mediocrity. In conclusion, the biggest challenge of professions given low social value is the recognition and not only the salary redistribution. This significant challenge for Peruvian nursing does not mainly relate to legal professionalization, but professionalism, which must result in greater legitimacy and autonomy.

This study uses YouTube content to explore trends in nursing start-ups. YouTube content can be used to understand the current trends regarding interest and awareness in various fields. The study was conducted in three stages: text mining, Delphi survey, and comparison. The frequency and degree centrality of keywords were analyzed in the text mining stage. In the Delphi survey, the 100 most frequent keywords were classified using a synthesis framework for nursing start-ups. In the comparison stage, the results of text mining and the Delphi survey were matched using a 2x2 matrix. Text mining identified "area," "business," "competence," "idea," and "success" as the most commonly used keywords. The keywords that showed the highest level of classification agreement in Delphi were "motivation," "advice," "obstacle," "business," "charisma," and "result." In the comparison using a 2x2 matrix, "dream," "idea," "opportunity," "leadership," "success," "benefit," and "satisfaction" emerged. The results indicate that interest in nursing start-ups develops at an early stage. In order to encourage nursing start-ups, it is necessary to strengthen business skills such as finance and budgeting, establish active policy support for such start-ups, and develop new nursing start-up items appropriate for the Fourth Industrial Revolution.

The free-lance nurse, not bound to rigid organizational systems, can offer personalized assistance always respecting the rights of the person and of the profession. More recent graduates have decided to undertake the nursing profession by moving towards the free-lance nursing, considering it both as a career opening and as a professional opportunity, although this option never got much attention from the researchers in the Italian nursing scene. Free-lance nursing is now considered a valuable opportunity to develop a nursing career. This market is destined to grow for different reasons, such as an increasing chronicity of health conditions of more and more ageing population and the deficits of the National Health Service (Servizio Sanitario Nazionale - SSN) in community and home care.The aim of the study was to evaluate the correlation between the development of the free-lance nursing and the Italian socio-economic context.The design of the study was descriptive - observational. Data collection and observation was carried out from January 2018 until April 2108. For the analysis a linear regression model was adopted to quantify a cause-effect relationship between one or more independent variables and the dependent variable which interprets the phenomenon investigated. The regression carried out was descriptive to analytically express the observed reality and represent it in a plausible way. The specification model was represented as: Free-lance nurses per capita = per capita income + Out of Pocket expense per capita + waiting lists in days + number of beds per inhabitants + NHS nurses per inhabitants.The estimate carried out had an R of 0.813, R-square equal to 0.6612, adjusted R-square 0.540 and standard error of the estimate 1.277, highlighting a correlation between the variables adopted in the model and a p = 0.005. From the analysis of the variables used, the average per capita income (p = 0.045) and the nurses working in the National Health Service /1,000 beds (p = 0.017) were statistically significant.It can be stated that the free-lance nursing profession is costly for patients and therefore develops more revenue where the average per capita income grows, but the research also seems to show that, where the National Health Service has too few nurses, the private demand increases in order to satisfy healthcare needs.

OBJECTIVE This replication study examined differences in RN perception of the professional practice environment (PPE) between salary- and hourly-wage compensation models over time. BACKGROUND A previous study demonstrated that nurses in a salary-wage model had a significantly higher perception of the PPE compared with their peers receiving hourly wages. METHODS A descriptive, comparative design was used to examine the Revised Professional Practice Environment (RPPE) scale of nurses in the same units surveyed in the previous study 2 years later. RESULTS Mean scores on the RPPE continued to be significantly lower for hourly-wage RNs compared with the RNs in the salary-wage model. CONCLUSIONS Nurses in an hourly-wage unit have significantly lower perceptions of the clinical practice environment than their peers in a salary-wage unit, indicating that professional practice perceptions in a salary-wage unit were sustained for a 2-year period and may provide a more effective PPE.

The literature on hospital admissions costs shows that classification of hospitalization systems such as the DRG system used in Italy, do not reflect the real cost of the production factors used, including those of nursing care in relation to the complexity of the hospital effort.This concept paper outlines the study protocol and the methodology used to measure nursing care in economic terms. The objective of the study is developed on the assumption of creating economic indicators from a quantitative analysis of nursing activities provided to specific patients, in order to determine not only who costs but also the reasons for the cost, and demonstrate the variability of nursing not only for DRG, but also each individual patient.A retrospective study and a longitudinal prospective study will be performed. In the first phase of the study, using a bottom-up Microcosting methodology the type, volume, time and costs of nursing activities for DRG will be determined and the incidence of nursing costs on reimbursement will be highlighted.In the second phase, the above analysis will be supplemented by the recognition of the complexity of individual cases measured through the Corridor Triage(Tri-CO), in order to figure out the incidence of costs of nursing activities on the reimbursement in relation to the level of care complexity. Main sources of data: hospital discharge card (SDO); Professional Assessment Instrument (PAI); datasets for collecting the time of delivery of nursing activities on PAI. Power calculation: For retrospective study, the survey will be conducted on a sample of 150 patients hospitalized in the first quarter of 2016. For the longitudinal prospective study, 150 patients will be included in the first quarter of 2017 after the structured introduction of Tri-CO as a valuation tool of care complexity. The sample examined is approximately 30% of the total number of admissions per year.The study started in February 2016 and the results are expected for May 2017. Through this study it is expected to verify whether by implementing a unbundling approach, ie the "unpacking" of the production factors (nursing activity costs) used for the explication of hospitalization, and by adopting a methodology based on standard analytical costs, a more detailed knowledge of the overall DRG rate data available today will be obtained, which is currently lacking of explicit notation of all the amounts that make up it.INTRODUZIONE. La letteratura disponibile sui costi dei ricoveri ospedalieri evidenzia che i sistemi di classificazione dei ricoveri, quali ad esempio il sistema DRG utilizzato anche in Italia, non rispecchiano i reali costi dei fattori produttivi utilizzati e tra questi quelli dell’assistenza infermieristica in relazione alla complessità dell’impegno profuso.Questo paper delinea il protocollo di studio e la metodologia utilizzata per la misurazione in termini economici dell’impegno infermieristico. L’oggetto dello studio si sviluppa sull’ipotesi di creare degli indicatori economici partendo da un’analisi quantitativa delle attività infermieristiche erogate a specifici pazienti, al fine di determinare non solo “chi” costa ma anche “perché” costa e di dimostrare la variabilità delle prestazioni infermieristiche non solo per DRG, ma per ogni singolo paziente.Verranno effettuati uno studio retrospettivo e uno studio prospettico longitudinale. Nella prima fase dello studio, utilizzando una metodologia Microcosting bottom-up, verranno determinati tipologia, volume, tempi e costi delle attività infermieristiche per DRG ed evidenziata l’incidenza dei costi delle attività infermieristiche sul rimborso. Nella seconda fase, l’analisi sopra descritta sarà integrata dalla rilevazione della complessità assistenziale dei singoli casi misurata attraverso il Triage di corridoio (Tri-CO) allo scopo di conoscere l’incidenza dei costi delle attività infermieristiche sul rimborso in relazione al livello di complessità assistenziale. Principali fonti dei dati: scheda di dimissione ospedaliera (SDO); Professional Assessment Instrument, (PAI); dataset per la raccolta dei tempi di erogazione delle attività infermieristiche presenti sul PAI. Potenza del campione: Per lo studio retrospettivo l’indagine sarà condotta su un campione di 150 pazienti, ricoverati nel primo quadrimestre del 2016. Per lo studio prospettico longitudinale verranno considerati 150 pazienti ricoverati nel primo quadrimestre 2017, dopo l’introduzione strutturata del Tri-CO quale strumento valutativo della complessità assistenziale. Il campione esaminato equivale a circa il 30% del numero totale di ricoveri effettuati nell’anno.Lo studio è iniziato a febbraio 2016 e i risultati sono attesi per maggio 2017. Attraverso questo studio ci si aspetta di verificare se attuando un approccio all’unbundling, ossia allo “spacchettamento” dei fattori produttivi, quali le attività infermieristiche utilizzati per l’esplicitazione del ricovero e tramite la metodologia dei costi standard analitici, si raggiunge una più dettagliata conoscenza del dato complessivo per tariffa DRG che attualmente manca di un’evidenziazione esplicita relativamente a tutti gli importi che lo compongono.

In the current healthcare environment, cost control is an ongoing concern of public and private payers and of healthcare administrators. For nursing leaders in this environment, a critical task is establishing nursing as a service line and communicating its value to the organization. The work of nurses needs to be better articulated and models such as the Fundamentals of Care Framework can assist in this. Also critical is presenting what is lost for patients and the hospital through missed care and its consequences when nurse staffing is inadequate. Economic analysis has found that when the cost savings from lower length of stay, reduced adverse outcomes, reduced admissions and other benefits of adequate staffing are taken into account, adequate staffing is affordable.

Children with acute mental health (MH) concerns increasingly present to Emergency Departments, and in the absence of an accessible MH bed, are admitted. This study estimated the hidden associated costs.All Emergency MH admissions over a 12-month period (2016) were identified (N=105). Costs associated with length of stay (LOS) and one-to-one nursing were calculated.The average Length of Stay for acute MH presentations was 6 days, there were 615 bed day associated with this cohort, totalling costs of €1,216,470, with an average cost/patient of €12,684. Sixty-eight patients (65%) required an average of 5 days of one-to-one nursing, totalling 335 days. Estimating that 40% of this was provided by agency staff, the hospital cost was €115,374. Taken together, the costs associated with primary Emergency Mental Health presentations is €1,331,844. Costs associated with patients who were previously known to MH services were €843,417.Despite an increasing number of dedicated MH beds, demand outweighs availability, and immediate access remains problematic, the default often being a paediatric admission. Adequate funding and appropriate use of these scare and costly resources must be part of national MH policy planning, especially with ongoing planning for the National Children's Hospital.

As we move toward a value-based health care system and payment models based on individual performance of providers, nurses are faced with a dilemma. Should we as a profession actively pursue the development of individual nurse performance metrics, analysis, benchmarks, and practice standards, similar to those being implemented for physicians? Or should we wait until these metrics are imposed by payers and policymakers with little or no input from nurses?

Background and Aim of the Study: The objective of this study is to demonstrate the feasibility of a possible fee system based on the performance of the nursing function, validating the theoretical and methodological assumption of an economic analysis for nursing. Method: The I.C.A. Methodology (Indexes of Complexity of Assistance) was chosen as a system able to produce the reading, in an economic sense, of nursing performance to a sufficiently accurate degree, by its use of “assistance settings” and “nursing assistance plans”. For the planning of assistance, the Nursing Interventions Classification (NIC) was used, as it is a validated and shared language. For the cost of each single operation/intervention and recovery, the “weight intervention” algorithm of the I.C.A. methodology was used. This research project was carried out in the form of a pilot study which investigated a sample of 30 patients, and a multi-center cross-sectional and observational retrospective study conducted on a sample of 135 patients coming from three Region of Liguria Hospitals. Results: The study was concerned with 165 cases. It highlighted 65 D.R.G.s, of which 17 were selected, containing comprehensively 61 cases. The results obtained confirm that it is possible to use this proposed approach to calculate the direct and indirect costs of nursing activity, and that it is also possible to compare it to the present D.R.G. system. Conclusions: It is necessary to create a multidisciplinary payment system for a patient’s care. This must be able to monitor the whole treatment process, and therefore all of the activities carried out for the patient’s benefit. The present D.R.G. system is not able to register the care provided by nursing services.

Aims and objective To estimate the increased care demand and medical costs caused by falls in nursing homes. Background There is compelling evidence that falls in nursing homes are preventable. However, proper implementation of evidence-based guidelines to prevent falls is often hindered by insufficient management support, staff time and funding. Design A three-round Delphi study. Methods A panel of 41 experts, all working in nursing homes in the Netherlands, received three online questionnaires to estimate the extra hours of care needed during the first year after the fall. This was estimated for ten falls categories with different levels of injury severity, in three scenarios, that is a best-case, a typical-case and a worst-case scenario. We calculated the costs of falls by multiplying the mean amount of extra hours that the participants spent on the care for a resident after a fall with their hourly wages. Results In case of a noninjurious fall, the extra time spent on the faller is on average almost 5 hr, expressed in euros that add to € 193. The extra staff time and costs of falls increased with increasing severity of injury. In the case of a fracture of the lower limb, the extra staff time increased to 132 hr, expressed in euros that is € 4,604. In the worst-case scenario of a fracture of the lower limb, the extra staff time increased to 284 hr, expressed in euros that is € 10,170. Conclusions Falls in nursing homes result in a great deal of extra staff time spent on care, with extra costs varying between € 193 for a noninjurious fall and € 10,170 for serious falls. Relevance to clinical practice This study could aid decision-making on investing in appropriate implementation of falls prevention interventions in nursing homes.

Background A survey of nursing administrators in the United States was conducted to solicit opinions about health economics (HE) course competencies for baccalaureate nursing programs. Purpose To provide rationale for intensifying educational efforts to increase nurses’ awareness about the value of HE skills in their everyday work. Methods Participants were asked to rate six HE competencies using a Likert scale. Paired-samples t tests, bivariate correlations, and standard multiple linear regressions were used to analyze survey results. Discussion A strong direct relationship exists between the amount of prior knowledge nursing administrators have about HE and the perceived level of usefulness of HE skills. Conclusion Nurses’ contributions to creating value in healthcare must be encouraged. Increasing the share and accessibility of the HE content in continuing education offerings could be one way to expand HE knowledge among practicing nurses and promote cost-effective delivery of healthcare in the United States.

Objective Staphylococcus aureus is involved in around 20% of nosocomial pneumonia cases. Vancomycin used to be the reference antibiotic in this indication, but new molecules have been commercialized, such as linezolid. Previous studies comparing vancomycin and linezolid were based on models. Comparing their real costs from a hospital perspective was needed. Methods We performed a bicentric retrospective analysis with a cost-minimization analysis. The hospital antibiotic acquisition costs were used, as well as the laboratory test and administration costs from the health insurance cost scale. The cost of each hospital stay was evaluated using the national cost scale per diagnosis related group (DRG), and was then weighted by the stay duration. Results Fifty-eight patients were included. All bacteria identified in pulmonary samples were S. aureus. The cost of nursing care per stay with linezolid was €234.10 (SD = 91.50) vs. €381.70 (SD = 184.70) with vancomycin (P = 0.0029). The cost of laboratory tests for linezolid was €172.30 (SD = 128.90) per stay vs. €330.70 (SD = 198.40) for vancomycin (P = 0.0005). The acquisition cost of linezolid per stay was not different from vancomycin based on the price of the generic drug (€54.92 [SD = 20.54] vs. €40.30 [SD = 22.70]). After weighting by the duration of stay observed, the mean cost per hospital stay was €47,411.50 for linezolid and €57,694.0 for vancomycin (NSD). Conclusion These results, in favor of linezolid, support other former pharmacoeconomic study based on models. The mean cost per hospitalization stay was not statistically different between the two study groups, but a trend in favor of linezolid is emerging.

A thorough systematic literature review comparing care for the elderly provided by physicians and nurses with that provided by physicians alone finds a modest advantage for the first. The conclusion is that 'Physician substitution in healthcare for the aging population may achieve at least as good patient outcomes and process of care outcomes compared with care provided by physicians'. On closer inspection, the selected studies compare multidisciplinary care programmes including nursing staff with monodisciplinary physician care. The modest advantage found for the multidisciplinary programmes can be seen as support for the prevailing consensus that this is the way to go, but the conclusion that this is support for the substitution of physicians lacks evidence. Focus on cost-effectiveness and/or the wish to accentuate the important role of highly trained nursing experts in modern care for older people may have affected the interpretation of the data.

Health care is expensive, and nurses, like everyone else, must use resources responsibly. At the start of a new financial year there is usually a focus on budgets: how much was spent last year, what is available for next year and how savings will be made.

The Council of Deans of Health has had more than a year of extensive engagement with the Nursing and Midwifery Council's standards for future registered nurses.

Globally, nurses constitute the largest segment of healthcare professionals; therefore, they are also the most expensive, and in a hospital these costs can reach 25% of the total expenditure.1 When costs are calculated, usually the monthly sum of nursing working hours and nursing labour costs is divided by the total number of patient days to produce mean general measures such as ‘nursing hours per patient’ or ‘nursing costs per patient day.’ This is only a general average cost calculation that takes into account large groups of nurses caring for large groups of patients, but through this system it is difficult to accurately control costs if the specific costs are unknown.2 In this regard, Needleman3 pointed to the ‘invisibility’ of a significant portion of nursing today, which explains why this discipline in many countries around the world is still not fully recognised by administrators, policymakers and the public. Invisible work includes monitoring patients, educating patients and families, preparing discharge plans, providing psychological support to patients who are seriously ill and their family members, and advocating for their patients. In the last few decades, the decreasing lengths of hospital stay of increasingly acute inpatients have been putting strong pressure in terms of time and intensity of care on nurses and this is inevitably leading to missed care.4 5 Missed care is an error of omission, defined as ‘any aspect of required care that is omitted either in part or in whole, or delayed.’6 In 2009, Kalisch and Williams also developed and validated a tool to measure missed care.6 Therefore, missed care is linked to the concept of ‘Complexity Compression,’7 which has been described as ‘what nurses experience when expected to assume additional, unplanned responsibilities while simultaneously conducting their multiple responsibilities in a condensed time frame.’8 …

Objective To evaluate the cost-effectiveness of nurse-led multifactorial care to prevent or postpone new disabilities in community-living older people in comparison with usual care.Methods We conducted cost-effectiveness and cost-utility analyses alongside a cluster randomized trial with one-year follow-up. Participants were aged >= 70 years and at increased risk of functional decline. Participants in the intervention group (n = 1209) received a comprehensive geriatric assessment and individually tailored multifactorial interventions coordinated by a community-care registered nurse with multiple follow-up visits. The control group (n = 1074) received usual care. Costs were assessed from a healthcare perspective. Outcome measures included disability (modified Katz-Activities of Daily Living (ADL) index score), and quality-adjusted life-years (QALYs). Statistical uncertainty surrounding Incremental Cost-Effectiveness Ratios (ICERs) was estimated using bootstrapped bivariate regression models while adjusting for confounders.Results There were no statistically significant differences in Katz-ADL index score and QALYs between the two groups. Total mean costs were significantly higher in the intervention group (EUR 6518 (SE 472) compared with usual care (EUR 5214 (SE 338); adjusted mean difference (sic) 1457 (95% CI: 572; 2537). Cost-effectiveness acceptability curves showed that the maximum probability of the intervention being cost-effective was 0.14 at a willingness to pay (WTP) of EUR 50,000 per one point improvement on the Katz-ADL index score and 0.04 at a WTP of EUR 50,000 per QALY gained.Conclusion The current intervention was not cost-effective compared to usual care to prevent or postpone new disabilities over a one-year period. Based on these findings, implementation of the evaluated multifactorial nurse-led care model is not to be recommended.

Objective The aims of this study were to design, pilot, and evaluate a care team model of shared accountability on medical-surgical units. Background American healthcare systems must optimize professional nursing services and support staff due to economic constraints, evolving Federal regulations and increased nurse capabilities. Methods A redesigned model of RN-led teams with shared accountability was piloted on 3 medical/surgical units in sample hospitals for 6 months. Nursing staff were trained for all functions within their scope of practice and provided education and support for implementation. Results Clinical outcomes and patient experience scores improved with the exception of falls. Nurse satisfaction demonstrated statistically significant improvement. Cost outcomes resulted in reduced total salary dollars per day, and case mix-adjusted length of stay decreased by 0.38. Conclusion Innovative changes in nursing care delivery can maintain clinical quality and nurse and patient satisfaction while decreasing costs.

The aim of the system is to achieve simplification of workflow, reduction of recording time, and increase the income for the study hospital.The project team decided to develop a multiple accounting record system that generates the account records based on the nursing records automatically, reduces the time and effort for nurses to review the procedure and provide another note of material consumption. Three configuration files were identified to demonstrate the relationship of treatments and reimbursement items.The workflow was simplified. The nurses averagely reduced 10 minutes of daily recording time, and the reimbursement points have been increased by 7.49%.The project streamlined the workflow and provides the institute a better way in finical management.

We report the findings of a big data nursing value expert group made up of 14 members of the nursing informatics, leadership, academic and research communities within the United States tasked with 1. Defining nursing value, 2. Developing a common data model and metrics for nursing care value, and 3. Developing nursing business intelligence tools using the nursing value data set. This work is a component of the Big Data and Nursing Knowledge Development conference series sponsored by the University Of Minnesota School Of Nursing. The panel met by conference calls for fourteen 1.5 hour sessions for a total of 21 total hours of interaction from August 2014 through May 2015. Primary deliverables from the bit data expert group were: development and publication of definitions and metrics for nursing value; construction of a common data model to extract key data from electronic health records; and measures of nursing costs and finance to provide a basis for developing nursing business intelligence and analysis systems.