A Feldstein

Bio: A Feldstein is an academic researcher. The author has contributed to research in topics: Health administration & Health care. The author has an hindex of 2, co-authored 2 publications receiving 241 citations.

The effect of health care working conditions on patient safety.

Abstract: Do the working conditions of health care personnel contribute to the incidence of medical errors? This question is often raised during public discussion of ways to improve patient safety. How much do issues of nurse staffing and doctors’ hours, for example, contribute to the estimated 44,000 to 98,000 deaths per year in hospitals due to medical errors? The objective of this report is to identify and summarize evidence from the scientific literature on the effects of health care working conditions on patient safety. The report also identifies relevant information from industries outside of heath care. Working conditions were classified into five categories: workforce staffing, workflow design, personal/social factors, physical environment, and organizational factors. The classification system for working conditions was derived from existing literature and advice from an expert panel. It is consistent with human factors research in multiple disciplines and industries such as aviation and nuclear power. Workforce staffing refers to job assignments and includes four principal aspects of job duties: the volume of work assigned to individuals, the professional skills required for particular job assignments, the duration of experience in a particular job category, and work schedules. Workflow design focuses on the job activities of health care workers, including interactions among workers and the nature and scope of the work as tasks are completed. Personal/social factors refer to individual and group factors such as stress, job satisfaction, and professionalism. Physical environment includes aspects of the health care workplace such as light, aesthetics, and sound. Organizational factors are structural and process aspects of the organization as a whole, such as use of teams, division of labor, and shared beliefs. The researchers developed an analytic framework to define how working conditions are related to patient safety. Antecedent conditions, which are external factors such as personal characteristics of workers and fixed structural characteristics of the system (e.g., geographic location, regulations, and legislation), can affect the impact of working conditions on patient safety. Working conditions are viewed either as resources that improve work quality or as demands that impede work quality. Working conditions potentially affect patient safety, which leads to patient outcomes. The researchers also developed a model of patient safety to help frame the key questions and provide a way to synthesize data reported in studies. The model is drawn from injury analysis and incorporates elements of both processes and outcomes. It is based on the relationships between medical errors (defined as the failure of a planned action to be completed as intended, or the use of a wrong plan) and adverse outcomes (injuries caused by health care rather than underlying disease).

Educational levels of hospital nurses and surgical patient mortality.

Abstract: ContextGrowing evidence suggests that nurse staffing affects the quality of care in hospitals, but little is known about whether the educational composition of registered nurses (RNs) in hospitals is related to patient outcomes.ObjectiveTo examine whether the proportion of hospital RNs educated at the baccalaureate level or higher is associated with risk-adjusted mortality and failure to rescue (deaths in surgical patients with serious complications).Design, Setting, and PopulationCross-sectional analyses of outcomes data for 232 342 general, orthopedic, and vascular surgery patients discharged from 168 nonfederal adult general Pennsylvania hospitals between April 1, 1998, and November 30, 1999, linked to administrative and survey data providing information on educational composition, staffing, and other characteristics.Main Outcome MeasuresRisk-adjusted patient mortality and failure to rescue within 30 days of admission associated with nurse educational level.ResultsThe proportion of hospital RNs holding a bachelor's degree or higher ranged from 0% to 77% across the hospitals. After adjusting for patient characteristics and hospital structural characteristics (size, teaching status, level of technology), as well as for nurse staffing, nurse experience, and whether the patient's surgeon was board certified, a 10% increase in the proportion of nurses holding a bachelor's degree was associated with a 5% decrease in both the likelihood of patients dying within 30 days of admission and the odds of failure to rescue (odds ratio, 0.95; 95% confidence interval, 0.91-0.99 in both cases).ConclusionIn hospitals with higher proportions of nurses educated at the baccalaureate level or higher, surgical patients experienced lower mortality and failure-to-rescue rates.

Association of Interruptions With an Increased Risk and Severity of Medication Administration Errors

Abstract: Background: Interruptions have been implicated as a cause of clinical errors, yet, to our knowledge, no empirical studies of this relationship exist. We tested the hypothesis that interruptions during medication administration increase errors. Methods: We performed an observational study of nurses preparing and administering medications in 6 wards at 2 major teaching hospitals in Sydney, Australia. Procedural failures and interruptions were recorded during direct observation. Clinical errors were identified by comparing observational data with patients’ medication charts. A volunteer sample of 98 nurses (representing a participation rate of 82%) were observed preparing and administering 4271 medications to 720 patients over 505 hours from September 2006 through March 2008. Associations between procedural failures (10 indicators; eg, aseptic technique) and clinical errors (12 indicators; eg, wrong dose) and interruptions, and between interruptions and potential severity of failures and errors, were the main outcome measures. Results: Each interruption was associated with a 12.1% increase in procedural failures and a 12.7% increase in clinical errors. The association between interruptions and clinical errors was independent of hospital and nurse characteristics. Interruptions occurred in 53.1% of administrations (95% confidence interval [CI], 51.6%-54.6%). Of total drug administrations, 74.4% (n=3177) had at least 1 procedural failure (95% CI, 73.1%-75.7%). Administrations with no interruptions (n=2005) had a procedural failure rate of 69.6% (n =1 395; 95% CI, 67.6%-71.6%), which increased to 84.6% (n=148; 95% CI, 79.2%-89.9%) with 3 interruptions. Overall, 25.0% (n=1067; 95% CI, 23.7%26.3%) of administrations had at least 1 clinical error. Those with no interruptions had a rate of 25.3% (n=507; 95% CI, 23.4%-27.2%), whereas those with 3 interruptions had a rate of 38.9% (n=68; 95% CI, 31.6%-46.1%). Nurse experience provided no protection against making a clinical error and was associated with higher procedural failure rates. Error severity increased with interruption frequency. Without interruption, the estimated risk of a major error was 2.3%; with 4 interruptions this risk doubled to 4.7% (95% CI, 2.9%-7.4%; P.001). Conclusion: Among nurses at 2 hospitals, the occurrence and frequency of interruptions were significantly associated with the incidence of procedural failures and clinical errors.

Why do nurses abuse patients? Reflections from South African obstetric services - Social Science & Medicine - Vol. 47, 11 - ISBN: 02779536 - p.1781-1795

Abstract: Afrique du Sud. La violence des personnels infirmiers a travers des entretiens individuels et de groupe, pour les soins en maternite. La violence est liee a au besoin d'identite professionnelles et de classe moyenne des soignants, et banalisee du fait de la non responsabilite du systeme et des cadres. Sous-tendue par l'idee d'une inferiorite des patients

The relationship of organizational culture, stress, satisfaction, and burnout with physician-reported error and suboptimal patient care: results from the MEMO study.

Abstract: Background A report by the Institute of Medicine suggests that changing the culture of health care organizations may improve patient safety. Research in this area, however, is modest and inconclusive. Because culture powerfully affects providers, and providers are a key determinant of care quality, the MEMO study (Minimizing Error, Maximizing Outcome) introduces a new model explaining how physician work attitudes may mediate the relationship between culture and patient safety. Research questions (1) Which cultural conditions affect physician stress, dissatisfaction, and burnout? and (2) Do stressed, dissatisfied, and burned out physicians deliver poorer quality care? Methods A conceptual model incorporating the research questions was analyzed via structural equation modeling using a sample of 426 primary care physicians participating in MEMO. Findings Culture, overall, played a lesser role than hypothesized. However, a cultural emphasis on quality played a key role in both quality outcomes. Further, we found that stressed, burned out, and dissatisfied physicians do report a greater likelihood of making errors and more frequent instance of suboptimal patient care. Practice implications Creating and sustaining a cultural emphasis on quality is not an easy task, but is worthwhile for patients, physicians, and health care organizations. Further, having clinicians who are satisfied and not burned out or stressed contributes substantially to the delivery of quality care.

Nurse working conditions and patient safety outcomes

Abstract: Background:System approaches, such as improving working conditions, have been advocated to improve patient safety. However, the independent effect of many working condition variables on patient outcomes is unknown.Objective:To examine effects of a comprehensive set of working conditions on elderly p