Organization of Healthcare Delivery

Streamlining how health care is delivered in the U.S.’s fragmented system.

Performance of a Clinical Decision Support Tool to Identify PICU Patients at High Risk for Clinical Deterioration

Heather Wolfe, MD
Oct. 2, 2019

Maya Dewan, Naveen Muthu, Eric Shelov, Christopher Bonafide, Patrick Brady, Daniela Davis, Eric Kirkendall, Dana Niles, Robert Sutton, Danielle Traynor, Ken Tegtmeyer, Vinay Nadkarni, Heather Wolfe

Abstract [from journal]

Objectives: To evaluate the translation of a paper high-risk checklist for PICU patients at risk of clinical deterioration to an automated clinical decision support tool.

Design: Retrospective, observational cohort study of an automated clinical decision support tool, the PICU Warning Tool, adapted from a paper checklist to predict clinical deterioration events in PICU patients within 24 hours.

Setting: Two quaternary care medical-surgical PICUs—The Children’s Hospital of Philadelphia and...

Fast-tracking Behavioral Health Care

Sep. 17, 2019

Imagine struggling with a behavioral health issue, searching for a local psychiatrist, and finding out the provider you’ve chosen doesn’t accept insurance. You wouldn’t be alone: most psychiatrists in the United States don’t. But let’s say your plan has some out-of-network benefits, which means you pay the full cost up front and request an itemized receipt for every appointment.

Determining the Association Between End-of-Life Care Resources and Patient Outcomes in Pennsylvania ICUs

Aug. 27, 2019

Deepshikha Ashana, Craig Umscheid, Alisa Stephens-Shields, Rachel Kohn, Vanessa Madden, Michael Harhay, Yong Chen, Meeta Kerlin

Abstract [from journal]

Objectives: As ICUs are increasingly a site of end-of-life care, many have adopted end-of-life care resources. We sought to determine the association of such resources with outcomes of ICU patients.

Design: Retrospective cohort study.

Setting: Pennsylvania ICUs.

Patients: Medicare fee-for-service beneficiaries.

Interventions: Availability of any of one hospital-based resource ( palliative care consultants) or four ICU-based resources (

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Linking the Work Environment to Missed Nursing Care in Labor and Delivery

Eileen Lake, PhD, RN
Aug. 26, 2019

Eileen Lake, Rachel French, Kathleen O'Rourke, Jordan Sanders, Sindhu K Srinivas

Abstract [from journal]

Aim: To measure the association between the nurse work environment (NWE) and missed nursing care on labor and delivery (L&D) units.

Background: L&D units provide a sizable fraction of acute hospital services to a unique population that is a national and global priority. L&D nurses are the frontline providers during labor. Maternal morbidity and mortality may be influenced by the NWE and missed care.

Methods: This cross-sectional study utilized secondary data from 1,313 L&

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Capacity Pooling in Hospitals: The Hidden Consequences of Off-Service Placement

Aug. 23, 2019

Hummy Song, Anita L. Tucker, Ryan Graue, Sarah Moravick, Julius J. Yang

Abstract [from journal]

Hospital managers struggle with the day-to-day variability in patient admissions to different clinical services, each of which typically has a fixed allocation of hospital beds. In response, many hospitals engage in capacity pooling by assigning patients from a service whose designated beds are fully occupied to an available bed in a unit designated for a different service. This “off-service placement” occurs frequently, yet

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Incongruence of Patient Problem Information Across Three Phases of Home Care Admission: There's a Problem with the Problem List

Aug. 21, 2019

Paulina S. Sockolow, Natasha B. Le, Yushi Yang, Sheryl Potashnik, Ellen J. Bass, Kathryn H. Bowles

Abstract [from journal]

In home health care, the patient problem list is an important component of the admission and care planning processes and determines the subsequent care received. We examined the information received from the referring facilities and its relationship with the final patient problem list generated at home health care admission. Researchers observed 12 admissions and collected available documents related to the admission and care planning process. Problems identified in documents provided to admission nurses (input documents) and in documents subsequently

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Cognitive Biases Influence Decision-Making Regarding Postacute Care in a Skilled Nursing Facility

Aug. 21, 2019

Robert E Burke, Chelsea Leonard, Marcie Lee, Roman Ayele, Ethan Cumbler, Rebecca Allyn, S Ryan Greysen

Abstract [from journal]

Background: Decisions about postacute care are increasingly important as the United States population ages, its use becomes increasingly common, and payment reforms target postacute care. However, little is known about how to improve these decisions.

Objective: To understand whether cognitive biases play an important role in patient and clinician decision-making regarding postacute care in skilled nursing facilities (SNFs) and identify the most impactful biases.

Design: Secondary analysis of...

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