Effect of Relocation on Neuropsychiatric Symptoms in Elderly Adults Living in Long-Term Care.

OBJECTIVES: To determine the evolution of behavioral and psychiatric symptoms of dementia (BPSD) in nursing home (NH) residents after an environmental change through a relocation to a more architecturally suitable facility, while conserving the same medical staff. DESIGN: Prospective, single arm study. SETTING: Long-term care unit. PARTICIPANTS: NH residents (N=116; median age 82.3, range 75.5-89.2; median Neuropsychiatric Inventory for the Nursing Home (NPI/NH) score 22, range 11-34.5; 66.3% female), of whom 102 lived in regular units and 14 in specialized care units (SCUs). MEASUREMENTS: Neuropsychiatric symptoms were evaluated as part of a comprehensive geriatric assessment for each resident 1 week before the relocation and 3 times after the relocation (1, 4, 12 weeks) using the NPI/NH. RESULTS: A mixed-effect linear model found no significant change in global NPI/NH score in the regular unit and a significant decrease in overall NPI/NH score 4 weeks after relocation in the SCUs (ß-coefficient for time by SCU=-11.5, 95% confidence interval (CI)=-17.9-5.2, p < .001), reaching a total decrease of 13 points by 12 weeks after relocation (ß-coefficient for time by SCU=-12.8, 95% CI=-19.1-6.4, p < .001). A statistically significant decrease of 3 points for disinhibition, apathy, and agitation accompanied the NPI/NH score in the secured unit. An increase of 3 points in aberrant motor behavior was seen by 12 weeks after relocation in the SCU. CONCLUSION: Relocation to an architecturally different facility significantly reduced BPSD of NH residents 1 month after relocation. J Am Geriatr Soc 66:2183-2187, 2018.

It Takes a Village to Move a Hospital: Simulation Improves Intensive Care Team Preparedness for a Move to a New Site.

OBJECTIVES: To evaluate in-situ simulation to prepare a PICU to move to a new, redesigned unit. METHODS: The study setting is an academic PICU. This is a cross-sectional study using in-situ simulations of common PICU admissions. Postsimulation, participants completed a survey comparing the perception of preparedness pre- and postsimulation (via a 10-point Likert scale). Participants were resurveyed 6 months postmove to assess whether effects persisted. Qualitative data were obtained via thematic review of the survey comment section and from postsimulation debriefing. RESULTS: Response rates were initially 100% and 67% at the 6-month follow-up. In the initial phase, all questions had statistically significant improvements in post- versus presimulation scores. Participants felt better prepared (presimulation: 6.20, postsimulation: 7.90, P < .001) and more confident about caring for real patients (presimulation: 5.49, postsimulation: 7.41, P < .001). They felt more comfortable working in the new unit (presimulation: 5.65, postsimulation: 7.50, P < .001) and better able to deliver safe care (presimulation: 5.85, postsimulation: 7.60, P < .001). Six months postmove, participants still believed that simulation was helpful (7.43, SD: 2.20) and still reported improved team confidence (7.36, SD: 2.11). Only 1 of 28 participants preferred less simulation. Exercises were described as helpful in identifying process and latent patient safety issues. CONCLUSIONS: Our pediatric intensive care team found simulations to be beneficial in preparation for providing care to critically ill children in a complex new setting. Simulations uncovered latent process, personnel, and patient-safety issues that were addressed before actual patient care.

Moving a hospital: simulation - a way to co-produce safety healthcare facilities.

Moving a hospital is a critical period for quality and safety of healthcare. Change is very stressful for professionals. Workers who have experienced relocation of their place of work report deterioration in health status. Building a new hospital or restructuring a unit could provide an opportunity for improving safety and value in healthcare and for ensuring better quality of worklife for the staff. We used in situ simulation to promote experiential learning by training healthcare workers in the workplace in which they are expected to use their skills. In situ simulation was a way to design, plan, assess and implement a new healthcare environment before opening its doors for patient care. We can envisage that simulation will soon be used formally to identify potential problems in healthcare delivery and in staff quality of worklife in new healthcare facilities. Simulation is a way to co-produce a safe and valuable healthcare facility.

Impact of the Relocation of a Long-term Residential Care Facility on Staff.

This article describes the relocation of residents and staff of a long-term residential care facility into a new state-of-the-art building in a Canadian province. All staff were surveyed about their perceptions of the moving process 2 months after the move occurred using a newly created 51-item questionnaire containing both open-ended and closed questions (5-point Likert scale). The results were positive for the 3 subscales of the survey, with average scores for premove, midmove, and postmove items of 3.67, 3.94, and 3.66, respectively. There was no significant difference in the means when comparing staff position, years of employment, or assignment to 1 or more units. Staff were very positive about the move itself, the orientation provided and overall planning, and support from coworkers and management. Some concerns were raised about staffing shortages, involvement of residents, and preparedness of the units and building. In addition, it is evident that relocation is an ongoing process, with many supports required in the months after the move. This article describes a very well planned and executed relocation of a long-term residential care facility and can provide guidance and lessons learned to assist other administrators who are planning a similar endeavor.

Virtual education: is it effective for preparing nurses for a hospital move?

OBJECTIVE: The objective of this study was to compare the effectiveness of using a virtual environment (VE) versus traditional paper floor plans (FPs) to prepare nurses for wayfinding in a new hospital building. BACKGROUND: This study was designed to control for variables such as task complexity and individual ability that have been missed in other media comparison studies. METHODS: Thirty nurses were assigned to the VE or FP condition using a randomized block experimental design. Subjects were blocked by alternate ranks on spatial/navigational ability and computer attitude/experience and randomly assigned to conditions. Nurses received instruction with either a VE or FP condition. Wayfinding tasks were then completed with trained observers at the new hospital under construction. RESULTS: The investigators found no significant differences between the wayfinding performance or postintervention confidence levels of subjects. Instruction using both media improved wayfinding and navigation skills. Qualitative findings suggest that interactions of the instructional style, media, and learner influence information retention and transfer. CONCLUSIONS: Although the virtual media did not prove to be more effective than FPs, it was equally effective for learning wayfinding and navigation skills in a new hospital. Nursing leaders may want to consider use of 3-dimensional VEs as an early method to provide repetitive practice for learning how to navigate a new large-scale space.

Going viral: adapting to pediatric surge during the H1N1 pandemic.

OBJECTIVES: The objective of this study was to assess hospital and emergency department (ED) pediatric surge strategies utilized during the 2009 H1N1 influenza pandemic as well as compliance with national guidelines. METHODS: Electronic survey was sent to a convenience sample of emergency physicians and nurses from US EDs with a pediatric volume of more than 10,000 annually. Survey questions assessed the participant's hospital baseline pandemic and surge preparedness, as well as strategies for ED surge and compliance with Centers for Disease Control and Prevention (CDC) guidelines for health care personal protection, patient testing, and treatment. RESULTS: The response rate was 54% (53/99). Preexisting pandemic influenza plans were absent in 44% of hospitals; however, 91% developed an influenza plan as a result of the pandemic. Twenty-four percent reported having a preexisting ED pandemic staffing model, and 36% had a preexisting alternate care site plan. Creation and/or modifications of existing plans for ED pandemic staffing (82%) and alternate care site plan (68%) were reported. Seventy-nine percent of institutions initially followed CDC guidelines for personal protection (use of N95 masks), of which 82% later revised their practices. Complete compliance with CDC guidelines was 60% for patient testing and 68% for patient treatment. CONCLUSIONS: Before the H1N1 pandemic, greater than 40% of the hospitals in our study did not have an influenza pandemic preparedness plan. Many had to modify their existing plans during the surge. Not all institutions fully complied with CDC guidelines. Data from this multicenter survey should assist clinical leaders to create more robust surge plans for children.

Transitioning to a new nursing home: one organization's experience.

Restructuring of long-term care in Western Health, a regional health authority within Newfoundland and Labrador, created a unique opportunity to study the widespread impacts of the transition. Staff and long-term-care residents were relocated from a variety of settings to a newly constructed facility. A plan was developed to assess the impact of relocation on staff, residents, and families. Indicators included fall rates, medication errors, complaints, media database, sick leave, overtime, injuries, and staff and family satisfaction. This article reports on the findings and lessons learned from an organizational perspective with such a large-scale transition. Some of the key findings included the necessity of premove and postmove strategies to minimize negative impacts, ongoing communication and involvement in decision making during transitions, tracking of key indicators, recognition from management regarding increased workload and stress experienced by staff, engagement of residents and families throughout the transition, and assessing the timing of large-scale relocations. These findings would be of interest to health care managers and leadership team in organizations planning large-scale changes.

Your hospital is moving: concerns for the security leader.

The security staff is the key to the successful move of an entire hospital to a new facility, the author says. Planning for the move will force a security department to take on issues that have never been considered, he adds. In this article, he presents those security and safety issues for managers and directors to thoroughly examine and review.

Moving day: a case history.

Utilizing an Incident Command structure and organizational chart, a health system successfully moved 144 patients and related services to a new facility 3.5 miles away in four hours. In this article, the author describes the planning that was involved and the key role that was played by the Security Department.

Experiencia acerca del traslado de un hospital general y su repercusión en la actividad asistencial / Experience of the moving day of a general hospital and effect on clinical activity

Objetivos Describir el proceso del día del traslado de un hospital general. Analizar el impacto en la actividad asistencial en los primeros meses después del traslado. Método Hospital general de ámbito comarcal, en Cataluña, que se traslada a un nuevo edifico. Se describe el proceso del traslado de los pacientes y se analiza el impacto en la actividad (se comparan 3 meses a partir del traslado [período 2] con los mismos meses del año anterior [período1]).Resultados Se trasladaron 37 pacientes sin incidencias. Se atendieron 18.786 urgencias en el período 1 y 21.266 en el período 2 (+13,2%). El número de ingresos urgentes/programados fue de 1314/803 en el período 1 y de 1427/979 en el período 2 (+8,59%/+21,91%). Las visitas realizadas en consultas externas fueron 32.116 en el período 1 y 30.777 en el período 2 (-4,16%)Conclusiones Una adecuada planificación y coordinación permitió realizar un traslado de hospital sin incidencias y sin reducir la actividad asistencial(AU)

Objectives To describe the moving day of a general hospital and to analyze the impact on clinical activity in the first few months after the move. Methods We describe the process of patient transfer and analyze the impact on activity of moving a regional general hospital in Catalonia (Spain) to a new building. Activity was compared in two periods: the first 3 months after the move (period 2) and the same 3 months in the previous year (period 1).Results We moved 37 patients without incidents. A total of 18,786 patients were admitted to the emergency room in period 1 and 21,266 were admitted in period 2 (+13.2%). The number of admissions from the emergency room vs elective admissions was 1,314/803 in period 1 and 1,427/979 in period 2 (+8.59%/ +21.91%). The number of outpatient visits in period 1 was 32,116 and 30,777 in period 2 (-4.16%).Conclusions Proper planning and coordination allowed the hospital to be moved without incidents and without decreasing activity(SU)

[The worries and anxieties of nurses involved in the reorganization of a department]. / Le preoccupazioni degli infermieri coinvolti in un progetto di riorganizzazione dipartimentale.

INTRODUCTION: The change process generally elicits reactions not always positive, although expected. AIM: To describe the reactions to change before and after one year from implementation. METHODS: A questionnaire was administered to a group of nurses before and after their wards was moved to a new surgical department with a totally different organization. RESULTS: The nurses remained moderately worried before and after the change. Worries for the impact of the change on the patients and themselves significantly increased. Nurses with 4-14 years of experience expressed higher levels of concern. CONCLUSIONS: The worries are a normal reaction but their better understanding may give indications on support strategies.

Menninger faces the 21st century.

The origin of the Menninger Clinic and Foundation stems from the vision of a family practitioner in a small midwestern community in the early 1900s, implemented with the participation of two sons who became psychiatrists. They articulated their hopes for the future of the institution in 1953, which surfaced only after the passing of the last founder in 1990. At that time, trends in healthcare financing were challenging the capacity of the institution they founded to fulfill its stated mission. This article reviews the origins and mission of Menninger, the challenges prompting a reassessment of operations and the search for an affiliate in order to fulfill the full institutional mission. Also cited are some principles for the future, and the impact on the midwestern community.

The tangled trail from Topeka to Houston: the Menninger Clinic-mid-1999 to mid-2003: a personal recollection.

This article traces many of the key events during the move of the Menninger Clinic from Topeka, Kansas, to Houston, Texas, and the affiliation with the Baylor College of Medicine and the Methodist Hospital in Houston. It is based on the personal recollections of John McKelvey, who was involved, in some form, in almost all aspects of the decision to move, the selection of the Houston location, the affiliation negotiations, and the final implementation of the relocation.

Transplanting an organization: how does culture matter.

Cultural differences are often cited as a major obstacle to the successful transition/integration into new situations of organizations. In this contribution, the author details the changing cultural factors impacting the operation and move of the Menninger Clinic from autonomous status to an affiliation with and first year of operation in the Baylor College of Medicine and Methodist Hospital Health Care System. Both functional and dysfunctional consequences are outlined, and specific examples illustrate how the organization's leadership and staff struggled to adapt during this complicated process. Based on the experience within the Clinic, general recommendations for managing such an acculturation are provided.