Silber, Jeffrey H
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Publication Hospital Nurse Staffing, Education, and Patient Mortality(2003-10-22) Aiken, Linda H; Clarke, Sean P; Silber, Jeffrey H; Sloane, Douglas MA serious shortage of hospital nurses in the U.S., evident in the past decade, is expected to continue and worsen in the next 15 years. Increasingly, the public and the health professions are acknowledging that nurse understaffing represents a serious threat to patient safety in U.S. hospitals. Although anecdotal evidence has linked patient deaths to inadequate nurse staffing, the numbers and kinds of nurses needed for patient safety is unknown. This Issue Brief highlights two studies that clarify the impact of nurse staffing levels on surgical patient outcomes, and examine the effect of nurses’ experience and educational level on patient mortality in the 30 days after a surgical admission.Publication A Wake-Up Call: Quality of Care After Resident Duty Hour Reform(2007-10-01) Volpp, Kevin G; Silber, Jeffrey HOn first glance, it seems self-evident: sleep-deprived physicians-intraining (residents) are more likely to make mistakes that could harm patients. Like pilots and truck drivers, these new physicians might need restrictions on how much they work. Such restrictions were created in 2003, but the impact of these new rules is unclear. Are patients any safer? Is hospital care more fragmented? Who’s doing the work that residents performed prior to duty hour reform? This Issue Brief summarizes several studies that offer evidence about the impact of these regulations on patient mortality, as well as on residents’ perceptions of the effects on quality of care, medical education, and residents’ quality of life.Publication Anesthesiologist Direction and Patient Outcomes(2000-10-16) Silber, Jeffrey HThe relationship between physicians and nurses in the delivery of anesthesia care is politically and financially charged, and hotly debated. Against this backdrop, federal regulators have proposed dropping a Medicare requirement that nurse anesthetists be supervised by a physician. Proponents note that the new regulations would resolve inconsistencies between Medicare supervisory requirements and state law, while opponents voice concerns for patient safety. This Issue Brief describes the current controversy, and summarizes a newly published study that suggests differences in patient outcomes depending on the nature and level of anesthesiologist involvement in surgical care.Publication Comparison of the Value of Nursing Work Environments in Hospitals Across Different Levels of Patient Risk(2016-01-20) Silber, Jeffrey H; Rosenbaum, Paul R; McHugh, Matthew D; Ludwig, Justin M; Even-Shoshan, Orit; Smith, Herbert L; Nikman, Bijan A; Fleisher, Lee A; Kelz, Rachel R; Aiken, Linda HHospitals with better nurse working environments provide better value (lower mortality with similar costs) especially for higher-risk surgical patients.Publication Time Under: Hospital and Patient Characteristics Affecting Anesthesia Duration(2007-02-26) Silber, Jeffrey HOne aspect of the quality of surgical care is the length of the time patients spend in the operating room and under anesthesia. It is generally believed that the longer a surgical procedure, the greater the chance of a complication. But because obtaining procedure and anesthesia times usually involves a direct review of medical records, few large-scale studies are able to examine procedure times. This Issue Brief summarizes new work that validates the use of Medicare billing data as a proxy for anesthesia times, and illustrates how these data can shed light on hospital and patient characteristics that affect procedure duration and surgical quality.