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The COVID-19 pandemic brought pain, stress and change on caregivers throughout healthcare organizations. Clinicians, already overburdened prior to the pandemic, suffered moral injury. Conditions and burnout drove the Great Resignation, creating record turnover. Out of necessity, contract labor was needed to care for waves of patients. The staffing crisis endures.
Despite a recent decline in contract labor use, staffing challenges, patient volumes and inflation have pushed health systems into ominous territory. According to consultancy Kaufman Hall, hospital costs have risen about 20% compared with pre-pandemic levels, while net operating revenue increased 15%. About half of U.S. hospitals ended 2022 with a negative margin.
The industry has also seen a decrease in healthcare quality and patient experience compared with standards before the pandemic, according to the Leapfrog Group. Reporting from the Centers for Disease Control and Prevention also shows significant increases in healthcare-acquired infections. A recent Gallup poll shows Americans’ perception of healthcare quality at a decade low.
Given these challenges, every healthcare leader knows they must change, but many don’t know how to start or lack a framework to build upon. Here are some suggestions:
Around 400 nursing homes have closed since 2020, according to Centers for Medicare and Medicaid Services data through January 2023. Nursing and residential care facilities shed more than 210,000 jobs over that span, Bureau of Labor Statistics data show.
“A lot of facilities do not have the personnel needed to take care of residents,” said Deb Burdsall, an infection prevention specialist and board member of the Association for Professionals in Infection Control and Epidemiology who worked in long-term care for more than 40 years.
Employment is slowly starting to rebound: Nursing homes filled an average of 3,700 jobs per month from May 2022 through January. But at that pace, it would take until 2027 for staffing at nursing homes to reach pre-pandemic levels, according to a recent report from the American Health Care Association and National Center for Assisted Living, which represents long-term care and post-acute providers.
“When I speak with my peers, all are suffering extreme staffing shortages, especially in nursing and nursing assistants,” said Tonja Myers, administrator of Christian Health Care Center, a nonprofit skilled-nursing and rehabilitation facility in Lynden, Washington. “Without those professionals in place, we cannot afford to take as many admissions as in the past.”
Christian Health Care Center only accepted 4% of referred patients in 2022 due to a lack of staffing, compared with 5% in 2021, 9% in 2020 and 17% in 2019.
“Without having [a patient] census at previous levels, we don’t have the revenue needed to stay in business,” Myers said. “Most of us long-term care facilities are using our savings to stay afloat, and many will close within the next year or two.”
The lack of workers has disrupted the care transition process, presenting potential dangers. Protracted waits can mean patients don’t get referred to the post-acute facilities best suited to treat their needs, said Jean Harpel, operations manager for aging services at ECRI, a patient safety organization.
A 2022 study published in the Journal of Patient Safety found that the longer patients were held in the emergency department after they were ready to be discharged, the more likely they were to experience a fall, medication error or other safety event.
COVID-19 outbreaks and prior authorization hurdles have also stalled hospital discharges, said Glen Roebuck, executive director of home, outpatient and senior services at Genesis Health System, which operates six hospitals and a network of home health, hospice, rehabilitation and long-term care facilities headquartered in the Quad Cities area of Iowa and Illinois. Pre-authorization processes cannot begin until a patient’s discharge is imminent, and insurers typically take between two to five business days to respond to authorization, prolonging hospital stays, Roebuck said.
The slowdowns can mean transitions take place after normal business hours, when skilled-nursing facilities don’t usually have physicians or pharmacists on site. Any potential gaps in care plans or pharmaceutical needs then become extraordinarily difficult to fill, he said.
“Those types of discharges come with great risk to the patient, as well as regulatory risk for the facility,” Roebuck said.
A looming regulation from CMS may further constrain nursing homes, operators warned. The agency announced plans in February 2022 to implement minimum staffing requirements by this spring in an attempt to improve safety across skilled-nursing facilities.
The move would disproportionately impact access to providers in rural settings, which already have trouble filling employment rosters, said Nathan Schema, president and CEO of Evangelical Lutheran Good Samaritan Society, a post-acute and home health provider that merged with Sanford Health in 2019.
12-year-old collapses, dies at New Jersey football practice
12-year-old collapses, dies at New Jersey football practice
02:41
Grieving mother Reven Brown is calling for all youth-league coaches to be CPR trained after her 12-year-old son collapsed and died while playing football last week.
“I’m numb right now. I’m crying,” Elijah’s mother Reven Brown told CBS New York.
After school on Feb. 10, Elijah Jordan Brown-Garcia and his 10-year-old brother took part in a football practice at West Side Park in Newark, New Jersey, with their team the Essex County Predators, CBS New York reported.
Elijah, who his mother said had no prior health issues, collapsed on the field. His younger brother called his mother, who was home.
“He said they were throwing water on him and they were fanning him,” Brown told CBS New York.
People on the field called 911 twice, and his mother called a third time, she said. She then rushed over to the football field. It wasn’t until 30 or 40 minutes later, Brown said, that an ambulance arrived to help her child.
The boy was taken to University Hospital in Newark, where he died. The family is awaiting autopsy results, Brown said.
Brown said she asked the Essex County Predators coach: “Why didn’t anyone know what to do?”
The coach, according to Brown, answered that no one on the field knew CPR. He pledged to get all coaches certified in CPR, she said.
“Our Hearts are crushed and our condolences screams out to the family of our very own Elijah E2 Brown. We love You,” the Essex County Predators wrote in an Instagram post.
Players ages 4 to 14 who participate in the league were able to receive mentoring and counseling, the team said in a registration flyer.
“Coaches out there need to be CPR certified,” Brown said. “He was a great kid. He didn’t deserve this.”
The on-field collapse of Buffalo Bills safety Damar Hamlin during a Jan. 2 NFL game, after suffering a cardiac arrest, has brought attention to heart health risks among adults and children.
The best way to be prepared for the potential is to have the training and equipment necessary to respond. Dr. Korin Hudson, a MedStar Health emergency physician told CBS News that if an AED — an automated external defibrillator is used within the first minute of collapse, the chances of survival are close to 90%. Each minute lost reduces the chance of survival by approximately 10%, said the Athletic Trainers’ Society of New Jersey.
Parents should know where the closest AED is, always have a way to dial 911, ask coaches if they know CPR, and make sure their school or club has an emergency action plan. In New Jersey, coaches employed by the state Department of Education are required to have CPR certification and first aid training, said the New Jersey State Interscholastic Athletic Association.
High school students are also required to learn CPR, as part of “Janet’s Law” — known as the “defibrillator law” — which was signed in 2012, and passed in 2014, and requires every district and school to have an AED available in an unlocked location on school property with an appropriate identifying sign. An AED must be accessible during the school day, and this includes physical education and recess, the law states.
The law falls short of mandating AEDs at any location hosting youth athletic events outside of school-sanctioned leagues. In 2015, a bill passed by New Jersey lawmakers was vetoed by then-Gov. Chris Christie. The former governor cited the wide scope of the bill in his veto message.
Latinos and African Americans are 30% less likely to have a bystander perform CPR on them in an emergency, according to American Heart Association (AHA) research. People who live in lower-income, African-American neighborhoods are 50% less likely to have CPR performed, said the AHA.
“Elijah was an outgoing, loving young kid,” wrote his family on their GoFundMe page, where they are raising money for his funeral and memorial.
“He loved dancing and football and loved his family. He made sure everyone was comfortable with his infectious smile. He loved going to school and he loved his friends,” his family wrote.
— Norah O’Donnell and Olivia Rinaldi contributed to this report.
Vinyl chloride entered the spotlight after the Feb. 3 Ohio train derailment. But the hazardous substance has been around for decades and is everywhere – from buildings and vehicle upholstery to children’s toys and kitchen supplies – and factories have been emitting the EPA-designated toxic chemical into the air for years.
The train that derailed had the manmade and volatile compound on board, prompting temporary evacuations amid concerns it could quickly impact people in the area. Then when officials decided to burn it, there were also concerns it could release phosgene, a gas that can be highly lethal and was used as a chemical weapon in WWI.
But the derailment isn’t the first time vinyl chloride has alarmed experts. They’ve been concerned about its potential impacts for decades.
On Jan. 2, the U.S. Department of Health and Human Services published a draft toxicological profile for the substance. In it, experts say that the volatile compound, “used almost exclusively by the plastics industry,” has “leached into groundwater from spills, landfills, and industrial sources,” and that people who live around plastic manufacturing facilities “may be exposed to vinyl chloride by inhalation of contaminated air.”
“This disaster is really a wakeup call,” Jimena Díaz Leiva, the science director for nonprofit Center for Environmental Health told CBS News. “…There needs to be a lot more regulatory oversight and action to address not just the safety and the actual transport around these chemicals, but also just stemming our production of all these chemicals.”
Díaz Leiva also said its risk has been underestimated – both in terms of its potential toxins and the greenhouse gas emissions involved in its production.
And in the U.S., there are dozens of places where such exposure is possible.
Smoke rises from a derailed cargo train in East Palestine, Ohio, on February 4, 2023.
DUSTIN FRANZ/AFP via Getty Images
The base for “poison plastic”
Vinyl chloride is the “essential building block of PVC plastic,” Díaz Leiva said.
“It’s an incredibly dirty process that emits a lot of chemicals and uses a lot of chemicals in the manufacturing process, resulting in a lot of worker exposures and also exposures of people in frontline and fenceline communities,” Díaz Leiva, who got her Ph.D. in environmental science, policy and management, said. “…PVC is called the poison plastic.”
The CEH published a report on polyvinyl chloride (PVC), a type of plastic used in pipes, buildings, packaging film, flooring and more, in 2018, saying, “the bottom line is there is no way to safely manufacture, use, or dispose of PVC products.”
The problem begins at vinyl chloride’s origins.
It’s generated from ethane, which is obtained through fracking natural gas, a process that’s significantly grown since 2013 and when done, emits the greenhouse gas methane – a major driver of climate change. PVC, according to a 2020 study, has a “high potential in global warming than other plastics” due to its high energy consumption and CO2 emissions.
The U.S. Energy Information Administration said ethane production hit a monthly record last year of more than 2.4 million barrels per day. They expect production will hit 2.7 million barrels per day this year, as the global PVC market is expected to become a $56.1 billion industry within the next 3 years.
According to the EPA’s Toxics Release Inventory (TRI), which “tracks the management of certain toxic chemicals that may pose a threat to human health and the environment,” there are 38 TRI facilities in 15 states – mostly around the Gulf of Mexico and the eastern U.S. – that use vinyl chloride, emitting about half a million pounds of the substance every year. In 2021, there were 428,523 pounds of the substance released, according to the EPA.
As of 2021, vinyl chloride ranks as one of the most released chemicals in the U.S. Out of 531 chemicals reported to the agency, the substance ranks 117th, with one being the highest releases.
Essentially all of those emissions came from the chemical industry in 2021 and were released into the air, and just five facilities made up more than half of those releases. The top emitter, Formosa Plastics Corp. Texas, sits along a bay leading into the Gulf of Mexico. They released more than 68,000 pounds of vinyl chloride into the air that year.
These numbers, however, may be lower than what’s true because not all facilities using the chemical compound are required to report to the EPA.
Chemical plants and factories line the roads and suburbs of the area known as ‘Cancer Alley’ are seen Oct. 15, 2013.
Giles Clarke / Getty Images
“An underestimated risk”
The emissions are known to have contributed to health issues in nearby communities.
Mossville, Lousiana, a tiny town just west of Lake Charles that was founded by people who were formerly enslaved, has been historically plagued by manufacturing pollution. The area is surrounded by more than a dozen industrial facilities, including at least one working with vinyl chloride that has a history of violations and scores far above national and industry levels for factors contributing to health issues. In 2021, the site was fined more than $447,000 for violations for failure to ensure performance, management safety, mechanical integrity and record keeping, among other things.
The area is part of what’s known as “cancer alley.”
“It’s a predominantly Black and Brown community. And a lot of the plastics manufacturing companies that are around there, these are the ones that are producing the same precursors that are getting us to PVC plastic and other types of plastics,” Díaz Leiva said.
Dr. Juliane Beier, assistant professor of medicine at Pittsburgh Liver Research Center and an expert who contributed to the DHHS report, told CBS News those most at-risk are occupational workers. But those in areas near PVC-producing factories could also face exposure.
How much vinyl chloride people can be subjected to before suffering health effects is still being researched, and different agencies have set different limits and recommendations.
The Occupational Safety and Health Administration, for example, says that workers should not be exposed to more than 1 ppm of vinyl chloride over an 8-hour period, or more than 5 ppm averaged over any period less than 15 minutes.
The Agency for Toxic Substances and Disease Registry, however, sets its minimal risk levels – the estimate of how much someone can ingest without a noticeable health impact – much lower.
Those who have been exposed for 14 days or less have an MRL of 0.5 ppm for inhalation, while those who have been exposed for 15 to 364 days have an MRL of 0.02 ppm.
Once in the air outside, vinyl chloride dissipates within a few days, so emissions from PVC production don’t necessarily pose a long-term or widespread impact. However, the ATSDR says areas near vinyl chloride manufacturing and processing plants, as well as waste sites and landfills, have seen a wide range of vinyl chloride concentrations. It’s usually a range from “trace amounts to over 1 ppm,” the agency says, but levels have gotten as high as 44 ppm around landfills.
Beier is currently researching exposure limits and the impact on livers, and told CBS News that at .08 ppm – which is less than the max threshold considered “safe” by OSHA standards – vinyl chloride could still impact health. The concentration at which it can impact health is also far lower than when it’s immediately detectable. The substance’s odor threshold – the concentration when most people can smell it – is 3,000 ppm in the air, according to the ATSDR.
“We have shown experimentally – this is not in humans – that these lower concentrations will enhance liver disease that is either pre-existing or caused by other factors,” she said. “And so that is one of my concerns…are there residents that have underlying liver disease?”
When asked if she there should be more concern about the hazards of vinyl chloride, Beier issued a swift response: “Yes.”
“We need to raise awareness that low levels of vinyl chloride that are currently considered safe may enhance underlying disease, this may be liver disease, but maybe also other disease,” she said. “…But this is, I think, an underestimated risk.”
“The whole vinyl chloride story is absolutely, absolutely under-studied and definitely needs more investigation,” Beier said.
Li Cohen
Li Cohen is a social media producer and trending content writer for CBS News.
Adventist Health is consolidating its seven care networks into five and laying off administrative staff to cut costs and strengthen operations.
The faith-based nonprofit said its five networks will be Northern California, Central California, Southern California, Oregon and Hawaii. Chief Operating Officer Todd Hofheins said in a Wednesday news release the reorganization will reduce overhead costs, strengthen operational structure and help broaden the system’s geographical footprint.
Roseville, California-based Adventist, which has 23 hospitals and more than 350 clinics, recently entered into an agreement for Mid-Columbia Medical Center to join its Oregon State Network, pending regulatory and state approval.
Adventist also is laying off 59 administrative employees, the system said in a Worker Adjustment and Retraining Notification Act notice filed with CaliforniaWednesday. Layoffs began this month and will continue into April, with affected positions ranging from administrative directors to project managers. Employees were given 60 days’ written notice of the pending cuts, according to the notice.
Adventist estimated the reorganization would save about $100 million but did not provide further details.
In July 2022, Adventist submitted a WARN notice of its plans to to lay off 52 employees.
Adventist reported a net loss of $637 million in the first nine months of 2022, according to its latest financial information. Revenue was up 4.4% year-over-year to $3.94 billion for that time period. Expenses increased 7.4% to $4.19 billion.
It is the latest in a string of health systems looking to streamline operations in response to a challenging economic environment.
Last year, Renton, Washington-based Providence condensed its seven regional divisions into three and cut executive positions. The nonprofit system attributed the change to financial challenges, including labor shortages, inflation, supply chain issues and limited insurance reimbursements. Also in 2022, Nashville, Tennessee-based HCA Healthcare shuffled its corporate structure, adding a third regional executive team to oversee five divisions starting this year, in contrast to other health systems cutting management layers.
In January, Jefferson Health in Philadelphia announced it would consolidate its five divisions into three in an effort to streamline operations, also citing labor challenges and inflationary pressures.
From increasing the use of sepsis bundles to streamlining diagnostic test ordering to improving patient satisfaction with consent procedures, medical students at the Ohio State University College of Medicine develop projects to solve real-world patient safety risks in clinical settings.
This coursework is part of the college’s four-year health system science studies focused on safety, quality and how different healthcare professions and specialties collaborate to improve patient care.
Rather than having health professionals wait to learn certain concepts until later on in their careers, some medical schools are beginning to incorporate patient safety into curricula so graduates enter the workforce more fully prepared.
“Why wait for a physician or a nurse or someone to be in practice for years before allowing them to take a course like this or receive certification?” said Dr. Frank Filipetto, dean of the Texas College of Osteopathic Medicine. ”Let’s not have them develop bad habits.”
However, medical schools must convince students and academic leaders that patient safety is worth prioritizing. Schools looking to implement safety curricula face barriers including student disinterest and uneven internal support for devoting resources to these initiatives.
“The biggest challenge was convincing students that they needed this curriculum and because it’s a change, and they don’t see other medical schools doing this,” Filipetto said. “I’ve had students say, ‘I don’t need to learn this.’” To counter these objections, professors explain how studying safety advantages students by enhancing their skills, in addition to benefiting patients, he said.
The Texas College of Osteopathic Medicine is among the innovators in this area. The school decided a few years ago to emphasize safety so students understand the importance of preventing harm, Filipetto said.
“My vision back then was: We really need to change the way healthcare is being delivered in this country because we have significant issues with medical errors and patient safety issues that result in death,” he said.
With assistance from the Institute for Healthcare Improvement and SaferCare Texas, the college first developed a curriculum and a pilot program to prepare 10 students for an IHI exam to qualify them for a Certified Professional in Patient Safety designation. Nine students passed on their first try, exceeding expectations, Filipetto said.
The Texas College of Osteopathic Medicine refined its safety curriculum and now requires a two-week course and the exam during the third year of medical school. Ninety-eight percent of graduates depart with patient safety certifications, according to the college.
Students learn about the foundations of patient safety, including hospital leadership, a culture of reporting adverse events, and measuring and improving performance. They also study how to identify root causes of safety failures to inform solutions.
More than 5,000 students have earned Certified Professional of Patient Safety designations since the exam debuted in 2012, said IHI Vice President Patricia McGaffigan. Since the Texas College of Osteopathic Medicine began its program, its graduates represent about 10% of those who have passed the test, she said. The IHI is seeking additional academic partners to expand its efforts, she said.
At the Ohio State University College of Medicine, health systems science students take a four-year course completing IHI quality and patient safety modules and engaging in group work to apply the lessons to clinical scenarios, said Dr. Philicia Duncan, program director of the school’s applied health systems science course.
During their final year, students engage in quality improvement projects that identify areas where care could be improved and work with faculty and others on quality and safety initiatives such as a campaign to reduce vaccine hesitancy.
The university ultimately wants safety incorporated into the entire curriculum, Duncan said. “That’s almost looked at as a niche area,” she said. “Once it’s demonstrated that patient safety and quality is more a fabric of medical education and medical practice, then that would help the program’s success.”
The University of Michigan Medical School takes a similar approach that is personalized for students based on their interests and future specialties, said Dr. Jawad Al-Khafaji, director of patient safety and quality improvement. Students also work on projects emphasizing measures to prevent adverse events, he said.
“We’ve had quite a few very impactful projects that ended up changing some of the practices even here at the University of Michigan” and at Veterans Health Administration facilities, said Al-Khafaji, who practices internal medicine at the VA Ann Arbor Healthcare System.
Medical school graduates who are certified in patient safety are attractive to employers because so few physicians have been formally educated on the subject, Filipetto said. Newly minted doctors with this background are prepared to perform duties such as participating in patient safety and quality committees, he said.
Trying to recruit first year medical students to join the patient safety elective over an area like global public health is difficult because most have no idea of what patient safety and quality improvement are or why they are important, Al-Khafaji said.
In addition to persuading students, advocates for patient safety education face skepticism from academic leaders, said Lillee Gelinas, director of patient safety at the Texas College of Osteopathic Medicine.
“The two most common questions we get—not just from medical schools, but other health profession schools—are: ‘How much does it cost and where does it fit in the curriculum?’” Gelinas said. “We can’t answer that. The schools have to look at their own curriculum and where it fits. But the main message is: You can’t just sprinkle the topic of safety and quality into other courses.”
Academic leaders often are reluctant to borrow best practices from other schools or from third parties, and contend they must create safety programs in-house from scratch, said Stephanie Mercado, CEO of the National Association for Healthcare Quality.
“One of the big misconceptions that I’ve experienced working with academic organizations is that they think that there’s a benefit to having a custom program built by their organization,” Mercado said. “They believe it represents a secret sauce, that they are bringing something to the market that no one else has,” she said.
“Programs who are trying to develop this de novo are going to miss the opportunity to have their students meet their peers where they’re at,” Mercado said. “They need to be speaking the same language, the same vocabulary, the same toolkit, and we do that by aligning to a standard.”
It was moments with his kids that made Jason Banner decide to take a chance on a new method of heart transplantation.
The single father of two discovered in 2005 he had a genetic heart condition. Last year, he was hospitalized with an irregular heartbeat that causes poor blood flow.
“They were basically telling me my heart was ready to give out at any moment,” Banner said.
He was transferred to Duke University Hospital for treatment while he awaited a heart transplant.
In 2022, almost 8,500 people were on the waitlist for heart transplants, but fewer than half received hearts because there weren’t enough donors, according to the United Network for Organ Sharing.
To increase his odds, Banner agreed to participate in a procedure called “donation after circulatory death.”
Traditionally, a heart is removed from a body and then placed on ice. The new method connects the heart to a machine that pumps blood through the organ.
“It allows it to recover and we can transport as far as we need to,” said Dr. Jacob Schroder, the surgical director of the heart transplant program at Duke University. “The use of this technology is the biggest thing to happen in heart transplant since heart transplant started.”
The new device expands the number of hearts available for transplant by increasing the distance the donor hearts can travel. Previously, hearts needed to be transplanted within approximately four hours. Doctors have successfully transplanted a heart that’s been in the machine for more than nine hours.
“We can go further and think about using hearts that are not going to be used just because of distance alone,” Schroder said.
Last June, Banner received a heart that was flown in from out-of-state that he would not have been able to get before.
“It has given me the opportunity to be here for my family,” he said.
All because an organ donor gave him another chance at life.
Jon LaPook
Dr. Jonathan LaPook is the chief medical correspondent for CBS News.
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