Managing Unnecessary Variability in Patient Demand to Reduce Nursing Stress and Improve Patient Safety

被引:83
作者
Litvak, Eugene [1 ,2 ]
Buerhaus, Peter, I [3 ]
Davidoff, Frank [4 ]
Long, Michael C. [5 ]
McManus, Michael L. [6 ]
Berwick, Donald M. [4 ]
机构
[1] Boston Univ, Program Management Variabil Hlth Care Delivery, Boston, MA 02215 USA
[2] Boston Univ, Hlth Care & Operat Management, Boston, MA 02215 USA
[3] Vanderbilt Univ, Sch Nursing, Nashville, TN 37240 USA
[4] IHI, Cambridge, MA USA
[5] Boston Univ, Operat Management, Boston, MA 02215 USA
[6] Childrens Hosp, Med Anesthesia & Crit Care, Boston, MA 02115 USA
关键词
D O I
10.1016/S1553-7250(05)31044-0
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Background: Increases in adverse clinical outcomes have been documented when hospital nurse staffing is inadequate. Since most hospitals limit nurse staffing to levels for average rather than peak patient census, substantial census increases create serious potential stresses for both patients and nurses. By reducing unnecessary variability, hospitals can reduce many of these stresses and thereby improve patient safety and quality of care. The Source and Nature of Variability in Demand: The variability in the daily patient census is a combination of the natural (uncontrollable) variability contributed by the emergency department and the artificial (potentially controllable) peaks and valleys of patient flow into the hospital from elective admissions. Once artificial variability in demand is significantly reduced, a substantial portion of the peaks and valleys in census disappears; the remaining census variability is largely patient and disease driven. When artificial variability has been minimized, a hospital must have sufficient resources for the remaining patient-driven peaks in demand, over which it has no control, if it is to deliver an optimal level of care. Discussion: Study of operational issues in health care delivery, and acting on what is learned, is critical. All forms of artificial variation in the demand and supply of health care services should be identified, and pilot programs to test operational changes should be conducted.
引用
收藏
页码:330 / 338
页数:9
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