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2007 AHA Survey of Hospital Leaders

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The 2007 State of America’s
Hospitals –
Taking the Pulse
Findings from the 2007 AHA Survey of Hospital Leaders
July 2007
Executive Summary
•
•
•
•
Hospitals face workforce shortages that are affecting patient care.
• Hospitals had an estimated 116,000 registered nurse vacancies
as of December 2006.
Nearly half of emergency departments (ED) are “at” or “over”
capacity.
• A majority of urban hospitals experience time on diversion.
• The most common reason for diversion is lack of staffed critical
care beds.
55% of hospitals experienced gaps in specialty coverage in the ED.
• Many hospitals are reporting increased difficulty maintaining
physician ED call coverage.
• More than a third of hospitals now pay for some physician
specialty ED call coverage.
• Coverage issues are most prevalent in orthopedics and
neurosurgery.
Hospitals are taking a variety of actions to bolster disaster
readiness including participation in large scale drills, establishing
back-up communications plans and developing resource sharing
plans with other hospitals.
Survey Methodology
• Survey was sent to approximately 5,000 community
hospital CEO’s in late February 2007 via fax and Email.
• Data was collected through March 2007.
• Unless otherwise specified, data reflects the above
mentioned time period.
• A total of 840 responses were received, a response rate
of approximately 17%.
Overview
• Workforce
• Hospital Capacity, Emergency Department Diversion
and Specialty Coverage
• Disaster Readiness
2007 Survey Results
WORKFORCE
Hospitals face workforce shortages in key caregiving professions…
Vacancy Rates for Selected Hospital Personnel, December 2006
11.4%
116,000 RN
Vacancies*
8.1%
8.1%
8.0%
6.6%
Therapists
(ST, OT, PT)
Registered
Nurses
Pharmacists
Nursing
Assistants
LPNs
5.9%
5.9%
Laboratory
Technicians
Imaging
Technicians
Source: 2007 AHA Survey of Hospital Leaders
Note: 116,000 vacancies is a national estimate created by extrapolating the vacancy rate to all 5,000 community
hospitals in 2005. ST: Speech Therapist, OT: Occupational Therapist, PT: Physical Therapist.
..that are perceived to be getting worse…
Percent of Hospitals Reporting Recruitment More Difficult in
2006 vs. 2005
Therapists (Speech,
Occupational and Physical)
58%
44%
Registered Nurses
Pharmacists
44%
Laboratory Technicians
41%
Imaging Technicians
28%
Billing/Coders
28%
22%
Nursing Assistants
20%
IT Technologists
19%
LPNs
17%
Housekeeping/ Maintenance
0%
10%
Source: 2007 AHA Survey of Hospital Leaders.
20%
30%
40%
50%
60%
70%
…and are affecting patient care.
Percent of Hospitals Reporting Service Impacts of Workforce
Shortage, 2006
Decreased Staff
Satisfaction
49%
ED Overcrowding
36%
Type of Impact
Decreased Patient
Satisfaction
35%
Diverted ED Patients
21%
Reduced Number of
Staffed Beds
17%
Delayed Discharge/ Increased
Length of Stay
17%
Increased Wait Times
to Surgery
13%
Discontinued Programs/
Reduced Service Hours
13%
Cancelled Surgeries
9%
Curtailed Acquisition of
New Technology
Curtailed Plans for Facility
Expansion
8%
6%
Source: 2007 AHA Survey of Hospital Leaders
17 percent of hospitals reported hiring foreigneducated* nurses in 2006.
Percent of Hospitals Reporting that They Hired Foreigneducated* Nurses to Help Fill RN Vacancies in 2006
Yes
17%
No
83%
Source: 2007 AHA Survey of Hospital Leaders
*Foreign-educated nurses are individuals who are foreign born and received basic nursing education in a foreign country.
In general many of these nurses come to the US on employment visas which allow them to obtain a green card.
42 percent of hospitals reported that they hired more
foreign-educated* nurses in 2006 vs 2005.
Percent of Hospitals Reporting More, Less or the Same
Number of Foreign-educated* Nurses to Fill Vacancies in 2006
vs 2005
Same
35%
More
42%
Less
23%
Source: 2007 AHA Survey of Hospital Leaders
*Foreign-educated nurses are individuals who are foreign born and received basic nursing education in a foreign country.
In general many of these nurses come to the US on employment visas which allow them to obtain a green card.
84 percent of those hospitals hiring foreign-educated
nurses recruited from the Philippines.
Percent of Hospitals Hiring Foreign-educated Nurses by
Country from which They Recruited, 2006
84%
33%
Philippines
Canada
29%
India
Source: 2007 AHA Survey of Hospital Leaders
9%
7%
Africa
China
6%
Korea
2007 Survey Results
HOSPITAL CAPACITY, EMERGENCY
DEPARTMENT DIVERSION AND
SPECIALTY COVERAGE
Nearly half of EDs are “at” or “over” capacity…
Percent of Hospitals Reporting ED Capacity Issues by Type of
Hospital, 2007
Urban Hospitals
30%
Rural Hospitals
35%
20%
Teaching Hospitals
11%
31%
27%
Non-teaching Hospitals
24%
All Hospitals
25%
0%
10%
65%
46%
18%
42%
48%
23%
20%
30%
40%
ED is "At" Capacity
Source: AHA 2007 Survey of Hospital Leaders
73%
50%
60%
ED is "Over" Capacity
70%
80%
…and a majority of urban and teaching hospitals
experience time on ED diversion…
Percent of Hospitals Reporting Time on Diversion in
Last 12 Months
56%
Urban
Rural
17%
Teaching
64%
Non-teaching
30%
All Hospitals
0%
36%
10%
20%
Source: AHA 2007 Survey of Hospital Leaders
30%
40%
50%
60%
70%
…most often caused by a lack of staffed
critical care beds.
Percent of Hospitals Citing Factor as Number One Reason for
Ambulance Diversion, January 2007
30%
Lack of Staffed Critical Care Beds
ED Overcrowded
29%
Lack of General Acute Care Beds
17%
12%
Staff Shortages
Lack of Specialty Physician
Coverage
7%
Lack of Psychiatric Beds
4%
0%
Source: AHA 2007 Survey of Hospital Leaders
10%
20%
30%
40%
For urban hospitals reporting diversion, nearly one in
eight was on diversion more than 20 percent of the time.
Percent of Time on Diversion in January 2007
(Among Urban Hospitals Experiencing Diversion in the Last 12 Months)
Percent of Time
on Diversion
No Diversion Time
20%
Up to 9.9% of Time
58%
10-19.9% of Time
9%
20% or More of Time
13%
0%
10%
20%
30%
40%
50%
60%
Percent of Urban Hospitals Experiencing Diversion
Source: AHA 2007 Survey of Hospital Leaders
70%
42 percent of hospitals reported an increase in
“boarding” behavioral health patients in the ED.
Percent of Hospitals Reporting Increases in “Boarding” Behavioral
Health Patients in the ED by Type of Hospital
Urban Hospitals
32%
Rural Hospitals
19%
22%
Teaching Hospitals
33%
11%
31%
Non-teaching Hospitals
26%
All Hospitals
27%
0%
10%
51%
52%
21%
13%
39%
42%
15%
20%
30%
Moderate Increase
40%
50%
60%
Significant Increase
Source: AHA 2007 Survey of Hospital Leaders
Note: Boarding is a term used when patients that are in need of inpatient psychiatric or substance
abuse services remain in the emergency department until a suitable placement can be found.
70%
55 percent of community hospitals experienced gaps
in specialty coverage in the ED.
Percent of Hospitals Losing Specialty Coverage in the ED for Any
Period of Time in Last 24 Months and Reasons Cited
Percent losing specialty coverage
55%
Physician lifestyle issues
41%
Inability to attract physicians
37%
Percent of
Physician retired or left
Above
Citing
Reason
Unaffordable on-call coverage
as Factor
in Loss of
Competition from Ambulatory Surgery Center
Coverage*
26%
26%
11%
Competition from another hospital
10%
Competition from specialty hosptial
6%
Physician liability concerns
6%
Source: AHA 2007 Survey of Hospital Leaders. *Respondents could check more than one reason for loss of specialty
coverage.
Maintaining ED coverage is becoming more difficult for
many hospitals in key specialty areas.
Percent of Hospitals Reporting Increased Difficulty in Maintaining
Physician ED Call Coverage by Selected Specialty in 2007
22%
Orthopedics
Neurosurgery
19%
Plastic Surgery
GI
13%
19%
13%
15%
11%
OB/GYN
10%
10%
8%
34%
32%
23%
9%
Somewhat more difficult
Source: AHA 2007 Survey of Hospital Leaders
36%
25%
10%
14%
Ophthalmology
36%
18%
21%
ENT
40%
14%
18%
General Surgery
Vascular Surgery
17%
22%
Hand Surgery
43%
24%
23%
Psychiatry
44%
22%
21%
18%
Significantly more difficult
Gaps in coverage were most often reported for
orthopedics and neurosurgery.
Percent of Hospitals Reporting Loss of Specialty Coverage for Any
Period of Time in 2007
26%
Orthopedics
Neurosurgery
25%
22%
Plastic Surgery
Hand Surgery
21%
ENT
19%
General Surgery
19%
Vascular Surgery
15%
Ophthalmology
15%
GI
10%
Psychiatry
OB/GYN
9%
7%
Source: AHA 2007 Survey of Hospital Leaders
More than a third of hospitals pay for some physician ED
on-call coverage.
Percent of Hospitals Reporting Payment for ED On-call Coverage by
Specialty, 2007
16%
General Surgery
Neurosurgery
9%
4%
12%
Orthopedics
OB/GYN
9%
Hand Surgery
Plastic Surgery
6%
Vascular Surgery
6%
3%
GI
5%
Ophthalmology
2% 1%
2%
21%
11%
2%
9%
18%
8%
6%
Some
Source: AHA 2007 Survey of Hospital Leaders
16%
13%
8%
2%
25%
22%
10%
2%
2%
31%
13%
3%
7%
33%
15%
4%
6%
13%
9%
Most
37%
16%
20%
4%
8%
Psychiatry
ENT
5%
All
2007 Survey Results
DISASTER READINESS
The majority of hospitals reported taking part in a largescale drill with external response agencies.
Hospitals Participating in Large-scale Community-wide Drills with
External Response Agencies in 2006
Yes, have already taken action
86%
No, but plan to take action in
6-12 months
No, but plan to take action when
resources permit
No action planned
Source: AHA 2007 Survey of Hospital Leaders
11%
3%
1%
85 percent of hospitals have established back up
systems for communication with police, fire etc.
Percent of Hospitals with Established Back-up Community-wide
Communications Ability, 2006
85%
Yes, have already taken action
No, but plan to take action in
6-12 months
No, but plan to take action when
resources permit
No action planned
Source: AHA 2007 Survey of Hospital Leaders
8%
5%
2%
The majority of hospitals have the ability to add more
bed capacity in the event of a disaster.
Chart 1.5: National Expenditures for Health
Number of Staffed Beds Hospitals Estimate
Could be Available in the
(1)
Services
and Supplies
Category,
Following
Time Periods
in the Event of by
a Disaster,
2007 1980
and 2005(2)
3.7%
8.1%
6.7%
17.2%
12.4%
16.1%
15.2%
30 or more beds
23.4%
20-29 beds
23.7%
21.0%
10-19 beds
5-9 beds
23.8%
13.0%
27.3%
10.2%
12.6%
11.8%
14.8%
11.1%
7.5%
8.3%
0-2 Hours
3-12 Hours
Source: AHA 2007 Survey of Hospital Leaders
11.2%
12+Hours
1-4 beds
No Additional
Beds
Unknown
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