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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
Vacancy Rates for Selected Hospital Personnel, December 2006
Hospitals face workforce shortages in key care-giving professions…
8.1% 8.1% 8.0%
6.6%5.9% 5.9%
11.4%
Therapists (ST, OT, PT)
RegisteredNurses
Pharmacists NursingAssistants
LPNs LaboratoryTechnicians
ImagingTechnicians
Source: 2007 AHA Survey of Hospital LeadersNote: 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.
116,000 RN Vacancies*
..that are perceived to be getting worse…
IT Technologists
Housekeeping/ Maintenance
Nursing Assistants
LPNs
Billing/Coders
Laboratory Technicians
Imaging Technicians
Pharmacists
Registered Nurses
Percent of Hospitals Reporting Recruitment More Difficult in 2006 vs. 2005
Source: 2007 AHA Survey of Hospital Leaders.
17%
19%
20%
22%
28%
28%
41%
44%
44%
58%
0% 10% 20% 30% 40% 50% 60% 70%
Therapists (Speech,Occupational and Physical)
…and are affecting patient care.
6%
8%
9%
13%
13%
17%
17%
21%
35%
36%
49%
ED Overcrowding
Diverted ED Patients
Reduced Number of Staffed Beds
Increased Wait Times to Surgery
Discontinued Programs/ Reduced Service Hours
Delayed Discharge/ Increased Length of Stay
Cancelled Surgeries
Curtailed Acquisition of New Technology
Curtailed Plans for Facility Expansion
Type o
f Im
pa
ct
Source: 2007 AHA Survey of Hospital Leaders
Percent of Hospitals Reporting Service Impacts of Workforce Shortage, 2006
Decreased Patient Satisfaction
Decreased Staff Satisfaction
17 percent of hospitals reported hiring foreign-educated* nurses in 2006.
No 83%
Yes 17%
Percent of Hospitals Reporting that They Hired Foreign-educated* Nurses to Help Fill RN Vacancies in 2006
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.
Same 35%
More 42%
Less 23%
Percent of Hospitals Reporting More, Less or the Same Number of Foreign-educated* Nurses to Fill Vacancies in 2006 vs 2005
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.
84%
33%29%
9% 7% 6%
Philippines Canada India Africa China Korea
Source: 2007 AHA Survey of Hospital Leaders
Percent of Hospitals Hiring Foreign-educated Nurses by Country from which They Recruited, 2006
2007 Survey Results
HOSPITAL CAPACITY, EMERGENCY DEPARTMENT DIVERSION AND
SPECIALTY COVERAGE
25%
24%
27%
20%
30%
23%
18%
46%
11%
35%
0% 10% 20% 30% 40% 50% 60% 70% 80%
All Hospitals
Non-teaching Hospitals
Teaching Hospitals
Rural Hospitals
Urban Hospitals
ED is "At" Capacity ED is "Over" Capacity
Nearly half of EDs are “at” or “over” capacity…
Percent of Hospitals Reporting ED Capacity Issues by Type of Hospital, 2007
Source: AHA 2007 Survey of Hospital Leaders
65%
31%
73%
42%
48%
…and a majority of urban and teaching hospitals experience time on ED diversion…
Percent of Hospitals Reporting Time on Diversion in Last 12 Months
36%
30%
64%
17%
56%
0% 10% 20% 30% 40% 50% 60% 70%
All Hospitals
Non-teaching
Teaching
Rural
Urban
Source: AHA 2007 Survey of Hospital Leaders
4%
7%
12%
17%
29%
30%
0% 10% 20% 30% 40%
…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
Source: AHA 2007 Survey of Hospital Leaders
Lack of Staffed Critical Care Beds
ED Overcrowded
Lack of General Acute Care Beds
Staff Shortages
Lack of Specialty Physician Coverage
Lack of Psychiatric Beds
Percent of Time on Diversion in January 2007(Among Urban Hospitals Experiencing Diversion in the Last 12 Months)
20%
58%
13%
9%
0% 10% 20% 30% 40% 50% 60% 70%
20% or More of Time
10-19.9% of Time
Up to 9.9% of Time
No Diversion Time
For urban hospitals reporting diversion, nearly one in eight was on diversion more than 20 percent of the time.
Source: AHA 2007 Survey of Hospital Leaders
Percent of Urban Hospitals Experiencing Diversion
Percent of Timeon Diversion
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
Source: AHA 2007 Survey of Hospital LeadersNote: 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.
27%
26%
31%
22%
32%
15%
13%
21%
11%
19%
0% 10% 20% 30% 40% 50% 60% 70%
All Hospitals
Non-teaching Hospitals
Teaching Hospitals
Rural Hospitals
Urban Hospitals
Moderate Increase Significant Increase
51%
33%
52%
39%
42%
Percent of Hospitals Losing Specialty Coverage in the ED for Any Period of Time in Last 24 Months and Reasons Cited
26%
26%
37%
41%
55%
6%
6%
10%
11%
Physician liability concerns
Competition from specialty hosptial
Competition from another hospital
Competition from Ambulatory Surgery Center
Unaffordable on-call coverage
Physician retired or left
Inability to attract physicians
Physician lifestyle issues
Percent losing specialty coverage
55 percent of community hospitals experienced gaps in specialty coverage in the ED.
Source: AHA 2007 Survey of Hospital Leaders. *Respondents could check more than one reason for loss of specialty coverage.
Percent of Above Citing
Reason as Factor in Loss of 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
Source: AHA 2007 Survey of Hospital Leaders
10%
11%
14%
15%
19%
21%
18%
22%
23%
19%
22%
8%
10%
9%
10%
13%
13%
18%
14%
17%
24%
22%
OB/GYN
Ophthalmology
GI
Vascular Surgery
ENT
General Surgery
Hand Surgery
Plastic Surgery
Psychiatry
Neurosurgery
Orthopedics
Somewhat more difficult Significantly more difficult
44%
43%
40%
25%
36%
34%
32%
36%
23%
21%
18%
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
Source: AHA 2007 Survey of Hospital Leaders
7%
9%
10%
15%
15%
19%
19%
21%
22%
25%
26%
OB/GYN
Psychiatry
GI
Ophthalmology
Vascular Surgery
General Surgery
ENT
Hand Surgery
Plastic Surgery
Neurosurgery
Orthopedics
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
Source: AHA 2007 Survey of Hospital Leaders
2%
5%
3%
6%
6%
7%
9%
8%
12%
9%
16%
1%
2%
2%
2%
2%
2%
3%
4%
4%
4%
5%
6%
6%
8%
8%
9%
11%
10%
13%
15%
20%
16%
Ophthalmology
GI
ENT
Vascular Surgery
Plastic Surgery
Hand Surgery
Psychiatry
OB/GYN
Orthopedics
Neurosurgery
General Surgery
Some Most All
37%
33%
31%
16%
22%
21%
18%
25%
13%
13%
9%
2007 Survey Results
DISASTER READINESS
1%
3%
11%
86%
The majority of hospitals reported taking part in a large-scale drill with external response agencies.
Hospitals Participating in Large-scale Community-wide Drills with External Response Agencies in 2006
Source: AHA 2007 Survey of Hospital Leaders
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
2%
5%
8%
85%
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
Source: AHA 2007 Survey of Hospital Leaders
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
Chart 1.5: National Expenditures for Health Services and Supplies(1) by Category, 1980 and 2005(2)
7.5% 8.3%11.2%
14.8% 11.1%11.8%
27.3%
12.6%10.2%
23.7%
23.8%
13.0%
16.1%
23.4%
21.0%
6.7%
12.4%
15.2%
3.7%8.1%
17.2%
0-2 Hours 3-12 Hours 12+Hours
30 or more beds
20-29 beds
10-19 beds
5-9 beds
1-4 beds
No AdditionalBedsUnknown
Source: AHA 2007 Survey of Hospital Leaders
Number of Staffed Beds Hospitals Estimate Could be Available in the Following Time Periods in the Event of a Disaster, 2007
The majority of hospitals have the ability to add more bed capacity in the event of a disaster.