Nurses on the outside, problems on the inside! The duty of nurses to support unions.

Healthcare is increasingly impacted by chronic short staffing of nurses, which causes and is caused by increased nurse burnout and decreased retention. Nurses' unions seek to address these problems by proposing safer nurse-to-patient ratios, retention bonuses for working through the COVID-19 pandemic, Personal Protective Equipment (PPE) stockpiles, sabbatical leaves, measures aimed at reducing workplace violence, and maintaining or increasing wages and benefits to keep nurses at the bedside. Chronic short staffing and burnout directly affect the quality and availability of patient care-as the International Council of Nurses has pointed out, there is no healthcare without healthcare workers.

Trauma Activation Fees Vary Widely Across US Trauma Centers.

Trauma activation fees are intended to help trauma centers cover the costs of providing lifesaving care at all times, but they have fallen under greater scrutiny because of a lack of regulation and wide variability in charges. We leveraged the federal Hospital Price Transparency rule to systematically describe trauma activation fees as captured in the Turquoise Health database for all Level I-III trauma centers nationally and across payer types. As of April 18, 2023, a total of 38 percent of US trauma centers published trauma activation fees.

The impact of health policy on surgical and trauma patients: Three key examples.

Health policy impacts the way surgical and trauma patients access, recover from, and pay for the medical care we deliver. In this editorial, we highlight 3 major policy directives that have or will affect millions of surgical and injured patients-Medicaid expansion, surprise billing, and housing in previously redlined districts. In doing so, we aim to elucidate the mechanisms by which health policies impact our patients and encourage participation and inquiry among surgeons when new health policies are being proposed at a national, state, or local level.

Improving outcomes in emergency general surgery: Construct of a collaborative quality initiative.

Background: Emergency general surgery conditions are common, costly, and highly morbid. The proportion of excess morbidity due to variation in health systems and processes of care is poorly understood. We constructed a collaborative quality initiative for emergency general surgery to investigate the emergency general surgery care provided and guide process improvements.

Sources of Postacute Care Episode Payment Variation After Traumatic Hip Fracture Repair Among Medicare Beneficiaries: Cross-Sectional Retrospective Study.

Unlabelled: The objective of this study was to evaluate how much variation in postacute care (PAC) spending after traumatic hip fracture exists between hospitals, and to what degree this variation is explained by patient factors, hospital factors, PAC setting, and PAC intensity.

Background: Traumatic hip fracture is a common and costly event. This is particularly relevant given our aging population and that a substantial proportion of these patients are discharged to PAC settings.

Financial toxicity after trauma and acute care surgery: From understanding to action.

Gains in inpatient survival over the last five decades have shifted the burden of major injuries and surgical emergencies from the acute phase to their long-term sequelae. More attention has been placed on evaluation and optimization of long-term physical and mental health; however, the impact of major injuries and surgical emergencies on long-term financial well-being remains a critical blind spot for clinicians and researchers. The concept of financial toxicity encompasses both the objective financial consequences of illness and medical care as well as patients' subjective financial concerns.

Association of Intellectual Disability with Delayed Presentation and Worse Outcomes in Emergency General Surgery.

Objective: To examine the association between intellectual disability and both severity of disease and clinical outcomes among patients presenting with common emergency general surgery (EGS) conditions.

Background: Accurate and timely diagnosis of EGS conditions is crucial for optimal management and patient outcomes. Individuals with intellectual disabilities may be at increased risk of delayed presentation and worse outcomes for EGS; however, little is known about surgical outcomes in this population.

High Deductibles are Associated With Severe Disease, Catastrophic Out-of-Pocket Payments for Emergency Surgical Conditions.

Background: Out-of-pocket spending has risen for individuals with private health insurance, yet little is known about the unintended consequences that high levels of cost-sharing may have on delayed clinical presentation and financial outcomes for common emergency surgical conditions.

Methods: In this retrospective analysis of claims data from a large commercial insurer (2016-2019), we identified adult inpatient admissions following emergency department presentation for common emergency surgical conditions (eg, appendicitis, cholecystitis, diverticulitis, and intestinal obstruction). Primary exposure of interest was enrollment in a high-deductible health insurance plan (HDHP).

Nurses' role model duties for health and COVID-19 pandemic precautions.

Role modelling communicates a standard of behavior to another person. Silent role modelling occurs when this standard can be communicated without articulating reasons for the action; articulate role modelling occurs when it is necessary to articulate reasons in order to effectively role model the standard of behavior, and to avoid misinterpretation. Nurses are role models in virtue of the respect and admiration given to the nursing profession.

Unmet Social Health Needs as a Driver of Inequitable Outcomes After Surgery: A Cross-sectional Analysis of the National Health Interview Survey.

Objective: This study aims to identify opportunities to improve surgical equity by evaluating unmet social health needs by race, ethnicity, and insurance type.

Background: Although inequities in surgical care and outcomes based on race, ethnicity, and insurance have been well documented for decades, underlying drivers remain poorly understood.

Methods: We used the 2008-2018 National Health Interview Survey to identify adults age 18 years and older who reported surgery in the past year.

Changes in Out-of-Pocket Spending and Catastrophic Health Care Expenditures Associated With Medicare Eligibility.

This study examines whether becoming eligible for Medicare is associated with less out-of-pocket health care spending and lower catastrophic health care expenditure risk.

Application of power analysis to determine the optimal reporting time frame for use in statewide trauma system quality reporting.

Background: Meaningful reporting of quality metrics relies on detecting a statistical difference when a true difference in performance exists. Larger cohorts and longer time frames can produce higher rates of statistical differences. However, older data are less relevant when attempting to enact change in the clinical setting.

Evaluating the complex association between Social Vulnerability Index and trauma mortality.

Introduction: Social determinants of health are known to impact patient-level outcomes, but they are often difficult to measure. The Social Vulnerability Index was created by the Centers for Disease Control to identify vulnerable communities using population-based measures. However, the relationship between SVI and trauma outcomes is poorly understood.

The Impact of Medicare Coverage on Downstream Financial Outcomes for Adults Who Undergo Surgery.

Objective: To evaluate the effects of gaining access to Medicare on key financial outcomes for surgical patients.

Summary Background Data: Surgical care poses a significant financial burden, especially among patients with insufficient financial risk protection. Medicare may mitigate the risk of these adverse circumstances, but the impact of Medicare eligibility on surgical patients remains poorly understood.

Targeting zero preventable trauma readmissions.

Background: Nearly 1-in-10 trauma patients in the United States are readmitted within 30 days of discharge, with a median hospital cost of more than $8,000 per readmission. There are national efforts to reduce readmissions in trauma care, but we do not yet understand which are potentially preventable. Our study aims to quantify the potentially preventable readmissions (PPRs) in trauma care to serve as the anchor point for ongoing efforts to curb hospital readmissions and ultimately, bring preventable readmissions to zero.

Insult to injury: National analysis of return to work and financial outcomes of trauma patients.

Background: While much of trauma care is rightly focused on improving inpatient survival, the ultimate goal of recovery is to help patients return to their daily lives after injury. Although the overwhelming majority of trauma patients in the United States survive to hospital discharge, little is known nationally regarding the postdischarge economic burden of injuries among trauma survivors.

Methods: We used the National Health Interview Survey from 2008 to 2017 to identify working-age trauma patients, aged 18 to 64 years, who sustained injuries requiring hospitalization.

Assessment of Potentially Preventable Hospital Readmissions After Major Surgery and Association With Public vs Private Health Insurance and Comorbidities.

Importance: Rehospitalization after major surgery is common and represents a significant cost to the health care system. Little is known regarding the causes of these readmissions and the degree to which they may be preventable.

Objective: To evaluate the degree to which readmissions after major surgery are potentially preventable.

The Affordable Care Act at 10 Years: Evaluating the Evidence and Navigating an Uncertain Future.

The year 2020 marks the 10th anniversary of the signing of the Affordable Care Act (ACA). Perhaps the greatest overhaul of the US health care system in the past 50 y, the ACA sought to expand access to care, improve quality, and reduce health care costs. Over the past decade, there have been a number of challenges and changes to the law, which remains in evolution.

Impact of Affordable Care Act-related insurance expansion policies on mortality and access to post-discharge care for trauma patients: an analysis of the National Trauma Data Bank.

Background: Uninsured trauma patients have worse outcomes and worse access to post-discharge care that is critically important for recovery after injury. Little is known regarding the impact of the insurance coverage expansion policies of the Affordable Care Act (ACA), most notably state-level Medicaid expansion, on trauma patients. In this study, we examine the national impact of these policies on payer mix, inpatient mortality, and access to post-acute care for trauma patients.

Lower emergency general surgery (EGS) mortality among hospitals with higher-quality trauma care.

Background: Patients undergoing emergency general surgery (EGS) procedures are up to eight times more likely to die than patients undergoing the same procedures electively. This excess mortality is often attributed to nonmodifiable patient factors including comorbidities and physiologic derangements at presentation, leaving few targets for quality improvement. Although the hospital-level traits that contribute to EGS outcomes are not well understood, we hypothesized that facilities with lower trauma mortality would have lower EGS mortality.

Potential impact of Affordable Care Act-related insurance expansion on trauma care reimbursement.

Background: Nearly one quarter of trauma patients are uninsured and hospitals recoup less than 20% of inpatient costs for their care. This study examines changes to hospital reimbursement for inpatient trauma care if the full coverage expansion provisions of the Affordable Care Act (ACA) were in effect.

Methods: We abstracted nonelderly adults (ages 18-64 years) admitted for trauma from the Nationwide Inpatient Sample during 2010-the last year before most major ACA coverage expansion policies.