Nurs Econ
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Private and public payers are increasingly seeking an overall per-diem or global surgery rates that put hospitals at significant financial risk for anesthesia services. Other payers are demanding deep discounts in anesthesia fees and negotiating global capitation rates that put both hospitals and physicians at risk for all care including anesthesia. ⋯ Four various anesthesia practice models are described in detail without declaring any one a universal model. The cost per year for MDAs averages $294,000 while the cost per year for CRNAs is less than half as much.
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The author suggests that one way to better manage the burgeoning costs in acute care settings and improve patient care is by the earlier use of ethics case consultations and end-of-life support from ethics teams. This study determined that, in several very diverse clinical scenarios, timely facilitation of meaningful communication and decision making between patients, families, and health care providers can result in the more appropriate use of health care resources. While few of the patients in this study had recorded advanced directives in place, and there was initially a lack of family consensus in some cases, compliance with the ethics team recommendations led to a more appropriate clinical unit placement; and improved family support helped manage the costs of care and focus on the patients' quality of life. The decrease in the use of medical interventions and therapies after ethics consultations was consistent in all cases presented here.
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The author exhaustively explores the current literature and attempts to summarize the current thinking on how to best decide on the most cost-effective nurse staffing requirements. Between 1984 and 1994 FTE nursing employees decreased by 7.3%, causing some researchers to seek ways to explore the relationship between staffing levels, staff and patient satisfaction and outcomes of care. ⋯ Work structure related studies seemed to find that 12-hour shifts were reported to be "less fatiguing" than traditional 8-hour shifts. Staffing studies found that rural hospitals still used 0.27 more RNs per occupied bed than urban hospitals and that the presence of a unit secretary was associated with a decreased use of RNs.