Medicaid Expansion & Colorectal Surgery
As the remaining non-expansion states consider expanding Medicaid eligibility, a new study offers encouraging evidence that Medicaid patients’ access to surgical care can be maintained even when enrollment surges.
Expanding Scope of Practice After COVID-19
To expand access to health care during the COVID-19 pandemic, many states relaxed or waived regulations that define the scope of health professional practice. This experience highlights the need to ensure that all health care professionals practice to the full extent of their capabilities—an issue that predates and will outlast the pandemic. In a virtual conference on November 20, 2020, Penn LDI and Penn Nursing brought together experts in law, economics, nursing, medicine, and dentistry to discuss current gaps in health professional scope of practice, what we have learned from COVID-19, and how to rethink scope of practice to better meet community and public health needs.
How Medical Schools Perpetuate Physician Bias
[Editor’s note: In a recent New England Journal of Medicine article, a team of researchers highlighted misrepresentations of race in U.S. medical school courses, and recommended ways to address the systemic racism that produces and reproduces these inaccuracies.
Pennsylvania Scope of Practice Policy Brief
Pennsylvania is one of 28 states that has not expanded the scope of practice in its licensure laws for certified registered nurse practitioners (NPs), who must maintain formal collaborative agreements with physicians to practice. For many years, proposals to update licensure and adapt it to make it more compatible with current models of collaborative care could not overcome legislative logjams. Recognizing an opportunity to break the logjam, the University of Pennsylvania held a virtual workshop on November 20, 2020, bringing together researchers, health professionals, and consumers to chart a new path forward. This policy brief summarizes their recommendations to update scope of practice regulation to better meet the primary care needs of Pennsylvanians.
Nurse Staffing and Outcomes of In-Hospital Cardiac Arrest
In-hospital cardiac arrests (IHCAs) are catastrophic and often terminal events. Despite improvements in resuscitation efforts, fewer than 25% of patients who experience an IHCA survive to discharge. Survival varies significantly across hospitals and by race. Racial disparities in IHCA survival have been linked, in part, to the quality of care during hospitalization.
Bringing Gynecologic Cancer Care Closer to Patients
For patients with gynecologic cancers, treatment by a specialist—a gynecologic oncologist—is crucial for improving chances of survival. However, in 2015, as many as 10% of women in the U.S. lived in a county that was more than 50 miles from the closest gynecologic oncologist.
Association of Police Transport With Survival Among Patients With Penetrating Trauma in Philadelphia, Pennsylvania
Eric Winter, Allyson M. Hynes, Kaitlyn Shultz, Daniel N. Holena, Neil R. Malhotra, Jeremy W. Cannon
Abstract [from journal]
Importance: Police in Philadelphia, Pennsylvania, routinely transport patients with penetrating trauma to nearby trauma centers. During the past decade, this practice has gained increased acceptance, but outcomes resulting from police transport of these patients have not been recently evaluated.
Objective: To assess mortality among patients with penetrating trauma who are transported to trauma centers by police vs by emergency medical services (EMS).
Design,
Effect of Text Messaging on Bowel Preparation and Appointment Attendance for Outpatient Colonoscopy: A Randomized Clinical Trial
Nadim Mahmud, David A. Asch, Jessica Sung, Catherine Reitz, Mary S. Coniglio, Caitlin McDonald, Donna Bernard, Shivan J. Mehta
Abstract [from journal]
Importance: Outpatient colonoscopy is important for colorectal cancer screening. However, nonadherence and poor bowel preparation are common.
Objective: To determine if an automated text messaging intervention with a focus on informational and reminder functions could improve attendance rates and bowel preparation quality for outpatient colonoscopy.
Design, setting, and participants: This randomized clinical trial was conducted in an endoscopy center at an urban
...Interprofessional Training and Communication Practices Among Clinicians in the Postoperative ICU Handoff
Scott Massa, Jasmine Wu, Cecilia Wang, Hannah Peifer, Meghan B. Lane-Fall
Abstract [from journal]
Background: Operating room (OR)-to-ICU handoffs require coordinated communication between clinicians with different professional backgrounds. However, individual studies have not simultaneously evaluated handoff training and OR-to-ICU handoff practices among interprofessional clinicians that participate in these team-based handoffs.
Methods: The objective of this study was to characterize communication training, practices, and preferences of interprofessional clinicians who engage in OR-to-ICU
...Implementing Resident Team Assistant Programs at Academic Medical Centers: Lessons Learned
Ryosuke Takei, George Dalembert, Jeanine Ronan, Nicole Washington, Stuti Tank, Michael Perry, John D. Mahan, David A. Stewart, Heather L. Burrows
Abstract [from journal]
Background: Excessive inpatient administrative tasks can lead to adverse consequences for residents and their patients. Furthermore, this burden has been linked to depersonalization, a major component of physician burnout.
Objective: To describe the development, implementation, feasibility, acceptability, and early outcomes of Resident Team Assistant (RTA) programs.
Methods: Three large academic medical centers created RTA programs in which
Informal Caregivers and Health Policy
Duty Hour Reform and the Outcomes of Patients Treated by New Surgeons
Despite concerns that duty hour reform might adversely affect the performance of new surgeons, this national study found no impact on patient outcomes, including 30-day mortality rates, failure-to-rescue, length of stay, and use of intensive care units. These findings should allay fears that reduced work hours during residency would produce surgeons less prepared for practice than their more experienced colleagues.
Evaluation of Hospital Nurse-to-Patient Staffing Ratios and Sepsis Bundles on Patient Outcomes
Karen B. Lasater, Douglas M. Sloane, Matthew D. McHugh, Jeannie P. Cimiotti, Kathryn A. Riman, Brendan Martin, Maryann Alexander, Linda H. Aiken
Abstract [from journal]
Background: Despite nurses’ responsibilities in recognition and treatment of sepsis, little evidence documents whether patient-to-nurse staffing ratios are associated with clinical outcomes for patients with sepsis.
Methods: Using linked data sources from 2017 including MEDPAR patient claims, Hospital Compare, American Hospital Association, and a large survey of nurses, we estimate the effect of hospital patient-to-nurse staffing ratios and adherence to the Early Management Bundle for patients with Severe Sepsis/...
Inside The Complexity of COVID Vaccine Distribution
Expanding Therapeutic Jurisprudence Across the Federal Judiciary
Benjamin A. Barsky, Heather Ellis Cucolo, Dominic A. Sisti
Abstract [from journal]
A patchwork of drug courts and other problem-solving courts currently exists to divert individuals with mental illness and substance use disorders away from the criminal justice system. We call for a broader implementation of problem-solving courts, particularly at the federal level, that would operate according to the principles of therapeutic jurisprudence (i.e., a framework that aims to maximize the health benefits of judicial and legislative policies and practices). Expanding federal problem-solving courts will better serve
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