The American journal of managed care
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"Sludge," or the frictions or administrative burdens that make it difficult for people to attain what they want or need, is an unexplored health care delivery factor that may contribute to deficiencies in colorectal cancer (CRC) screening. We piloted a method to identify and quantify sludge in a southeastern US health system's delivery of CRC screening services. ⋯ Our sludge audit method identified and quantified multiple instances of sludge in a health system's CRC screening processes. Sludge audits can help organizations to systematically evaluate and reduce sludge for more effective and equitable CRC screening.
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To develop a brief teamwork measure and determine how teamwork relates to provider experience, burnout, and work intentions. ⋯ The TEAM index is related to provider experience, burnout, and intent to stay, and it may help organizations optimize clinical work environments.
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Tele-intensive care unit (tele-ICU) use has become increasingly common as an extension of bedside care for critically ill patients. The objective of this work was to illustrate the degree of tele-ICU involvement in critical care processes and evaluate the impact of tele-ICU decision-making authority. ⋯ This study's findings suggest that higher levels of tele-ICU intervention do not negatively affect patient outcomes. Our results are a step toward understanding tele-ICU impact on patient outcomes by accounting for extent of decision-making authority, and they suggest that the level of remote intervention may reflect patient severity. Further research using more granular data is needed to better understand assignment of intervention category and how variable levels of authority affect clinical decision-making in tele-ICU settings.
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Due to the highly contagious nature of the Omicron variant of SARS-CoV-2 and its subvariants, a high rate of transmission was observed throughout Chengdu, China, within 2 weeks of the relaxation of COVID-19 measures on December 3, 2022, particularly in hospitals. Hospitals experienced different degrees of medical overcrowding during the first 2 weeks, with a high patient volume in the emergency departments and a significant lack of beds in the medical wards, particularly in the respiratory intensive care unit (ICU) and ICU. ⋯ It has been emulated by sister hospitals and was well received by the local populace and municipal government. The hospital made the following significant alterations and modifications to this emergency medical care: (1) immediate establishment of the General ICU (GICU), a temporary unit set up in emergency situations that had most of the functions of but was not as complete as the ICU and had a lower ratio of doctors to nurses; (2) dynamic adjustment of anesthesiologists and respiratory physicians jointly stationed in the GICU; (3) choice of nurses with extensive experience in internal medicine and allocation to the GICU according to a 2:3 ICU bed to nurse ratio; (4) emergency purchase or deployment of pneumonia-related treatment equipment; (5) implementation of the GICU resident rotation system; (6) "twinning" of internal medicine and other departments to add beds; and (7) implementation of uniform hospital bed allocation for inpatients.