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  1. A Medication Safety Model: A Case Study in Thai Hospital

    PubMed Central

    Rattanarojsakul, Phichai; Thawesaengskulthai, Natcha

    2013-01-01

    Reaching zero defects is vital in medication service. Medication error can be reduced if the causes are recognized. The purpose of this study is to search for a conceptual framework of the causes of medication error in Thailand and to examine relationship between these factors and its importance. The study was carried out upon an in-depth case study and survey of hospital personals who were involved in the drug use process. The structured survey was based on Emergency Care Research Institute (ECRI) (2008) questionnaires focusing on the important factors that affect the medication safety. Additional questionnaires included content to the context of Thailand's private hospital, validated by five-hospital qualified experts. By correlation Pearson analysis, the result revealed 14 important factors showing a linear relationship with drug administration error except the medication reconciliation. By independent sample t-test, the administration error in the hospital was significantly related to external impact. The multiple regression analysis of the detail of medication administration also indicated the patient identification before administration of medication, detection of the risk of medication adverse effects and assurance of medication administration at the right time, dosage and route were statistically significant at 0.05 level. The major implication of the study is to propose a medication safety model in a Thai private hospital. PMID:23985110

  2. Hospital financial audit of medical equipment maintenance: a case study.

    PubMed

    Baumeister, J

    1987-01-01

    Maintenance expense is becoming an area of importance in the business of health care. Methods for identification and determination of both types and amounts of expenses have also become important. This paper is a case study of one institution's total medical equipment maintenance expense, during the 1985/86 fiscal year. During this time, the total hospital medical maintenance expense was $683,614: of which $238,008 (34.8%) was salary; $85,858 (12.6%) was parts; $77,083 (11.3%) was contracts; $48,230 (7.1%) was service; $123,572 (18.1%) was X-ray tubes; $91,260 (13.3%) was maintenance insurance; $14,479 (2.1%) was for training; $1,212 (0.2%) was for operating expenses; and $3,912 (0.6%) was the 10-year amortized test-equipment expense. The maintenance-expense/acquisition-cost ratio was 4.36%. Arguments are presented on the need to obtain expense data that have some comparative value to other institutions and on developing benchmarks to be utilized in evaluating acceptable levels of expense.

  3. Graduate medical education funding: a Massachusetts General Hospital case study and review.

    PubMed

    Guss, Daniel; Prestipino, Ann L; Rubash, Harry E

    2012-02-15

    During the past century, graduate medical education funding has evolved in response to the increasing specialization of modern medicine as well as the need for federal funding to effectively sustain specialty training. This article reviews historical and current funding methods for graduate medical education and examines current funding using Massachusetts General Hospital (MGH) as a case example. Notably, it also explores whether graduate medical education funding at a large academic center such as MGH is commensurate with expenditures.

  4. Private medical services in the Italian public hospitals: the case for improving HRM.

    PubMed

    De Pietro, Carlo

    2006-08-22

    This study explores how Italian public hospitals can use private medical activities run by their employed physicians as a human resources management (HRM) tool. It is based on field research in two acute-care hospitals and a review of Italian literature and laws. The Italian National Health Service (NHS) allows employed physicians to run private, patient-funded activities ("private beds", surgical operations, hospital outpatient clinics, etc.). Basic regulation is set at the national level, but it can be greatly improved at the hospital level. Private activities, if poorly managed, can damage efficiency, equity, quality of care, and public trust in the NHS. On the other hand, hospitals can also use them as leverage to improve HRM, with special attention to three issues: (1) professional evaluation, development, and training; (2) compensation policies; (3) competition for, and retention of, professionals in short supply. The two case studies presented here show great differences between the two hospitals in terms of regulation and organizational solutions that have been adopted to deal with such activities. However, in both hospitals, private activities do not seem to benefit HRM. Private activities are not systematically considered in compensation policies. Moreover, private revenues are strongly concentrated in a few physicians. Hospitals use very little of the information provided by the private activities to improve knowledge management, career development, or training planning. Finally, hospitals do not use private activities management as a tool for competing in the labor market for health professionals who are in short supply.

  5. Medical social work practice in child protection in China: A multiple case study in Shanghai hospitals.

    PubMed

    Zhao, Fang; Hämäläinen, Juha; Chen, Yu-Ting

    2017-01-01

    With the rapid development of the child welfare system in China over recent years, medical social work has been increasingly involved in providing child protection services in several hospitals in Shanghai. Focusing on five cases in this paper, the exploratory study aims to present a critical overview of current practices and effects of medical social work for child protection, based on a critical analysis of the multidimensional role of social work practitioners engaged in the provision of child protection services as well as potential challenges. Implications and suggestions for future improvements of China's child protection system are also discussed.

  6. Medication safety in hospitals.

    PubMed

    Kirke, C

    2009-01-01

    Medication error and adverse drug reactions occur frequently, leading to a high burden of patient harm in the hospital setting. Many Irish hospitals have established medication safety initiatives, designed to encourage reporting and learning to improve medication use processes and therefore patient safety. Eight Irish hospitals or hospital networks provided data from voluntary medication safety incident and near miss reporting programmes for pooled analysis of events occurring between 1st January 2006 and 30th June 2007. 6179 reports were received in total (mean 772 per hospital; range 96-1855). 95% of reports did not involve patient harm. Forty seven percent of reports related to the prescribing stage of the medication use process, 40% to the administration stage and 9% to the pharmacy dispensing stage. This data is published to increase awareness of this key patient safety issue, to share learning from these incidents and near misses and to encourage a more open patient safety culture.

  7. [Intraosseous access for in-hospital emergencies. Intensive medical care case study].

    PubMed

    Werner, M; Daniel, H-P; Hoitz, J

    2010-07-01

    Since the release of the 2005 resuscitation guidelines intraosseous infusion has been recognized as the favorite alternative vascular access in emergency patients. It is no longer restricted to paediatric emergencies but is also considered the vascular access of choice for adult patients with difficult venous access. Intraosseous access has been used in an increasing proportion of patients especially in an out-of-hospital emergency care setting while only limited experience exists for in-hospital usage of this technique. This article reports on a case of intraosseous access performed in a critically ill patient directly after admission to the intensive care unit (ICU) due to difficult peripheral venous access. Despite the extensive medical resources available in the ICU (i.e. central venous catheterization) less invasive means were used to render appropriate care. Based on this case different strategies of critical care and possible improvements will be discussed. Intraosseous infusion should be regarded as an infrequently needed but potentially life-saving procedure that is still too often considered as an option at later stages during in-hospital emergency care.

  8. Hazardous medical waste generation in Greece: case studies from medical facilities in Attica and from a small insular hospital.

    PubMed

    Komilis, Dimitrios; Katsafaros, Nikolaos; Vassilopoulos, Panagiotis

    2011-08-01

    The accurate calculation of the unit generation rates and composition of medical waste generated from medical facilities is necessary in order to design medical waste treatment systems. In this work, the unit medical waste generation rates of 95 public and private medical facilities in the Attica region were calculated based on daily weight records from a central medical waste incineration facility. The calculated medical waste generation rates (in kg bed(-1) day( -1)) varied widely with average values at 0.27 ± 113% and 0.24 ± 121%, for public and private medical facilities, respectively. The hazardous medical waste generation was measured, at the source, in the 40 bed hospital of the island of Ikaria for a period of 42 days during a 6 month period. The average hazardous medical waste generation rate was 1.204 kg occupied bed(-1) day(-1) or 0.33 kg (official) bed( -1) day(-1). From the above amounts, 54% resulted from the patients' room (solid and liquid wastes combined), 24% from the emergency department (solid waste), 17% from the clinical pathology lab and 6% from the X-ray lab. In average, 17% of the total hazardous medical waste was solely infectious. Conclusively, no correlation among the number of beds and the unit medical waste generation rate could be established. Each hospital should be studied separately, since medical waste generation and composition depends on the number and type of departments/laboratories at each hospital, number of external patients and number of occupied beds.

  9. Hospital waste management status in Iran: a case study in the teaching hospitals of Iran University of Medical Sciences.

    PubMed

    Farzadkia, Mahdi; Moradi, Arash; Mohammadi, Mojtaba Shah; Jorfi, Sahand

    2009-06-01

    Hospital waste materials pose a wide variety of health and safety hazards for patients and healthcare workers. Many of hospitals in Iran have neither a satisfactory waste disposal system nor a waste management and disposal policy. The main objective of this research was to investigate the solid waste management in the eight teaching hospitals of Iran University of Medical Sciences. In this cross-sectional study, the main stages of hospital waste management including generation, separation, collection, storage, and disposal of waste materials were assessed in these hospitals, located in Tehran city. The measurement was conducted through a questionnaire and direct observation by researchers. The data obtained was converted to a quantitative measure to evaluate the different management components. The results showed that the waste generation rate was 2.5 to 3.01 kg bed(-1) day(-1), which included 85 to 90% of domestic waste and 10 to 15% of infectious waste. The lack of separation between hazardous and non-hazardous waste, an absence of the necessary rules and regulations applying to the collection of waste from hospital wards and on-site transport to a temporary storage location, a lack of proper waste treatment, and disposal of hospital waste along with municipal garbage, were the main findings. In order to improve the existing conditions, some extensive research to assess the present situation in the hospitals of Iran, the compilation of rules and establishment of standards and effective training for the personnel are actions that are recommended.

  10. [Medication safety in hospitals].

    PubMed

    Sleinitz, Annett; Heyde, Christian; Kloft, Charlotte

    2012-04-01

    Drug therapy is one of the most common therapeutic interventions in the medical care of in-patients. It is a complex risk-associated procedure, which is why risk prevention is of top priority in medication safety. Medical care in hospitals is organised via various forms of distribution, e.g. the traditional distribution on the ward or as computerised unit dose drug dispensing system. In order to improve medication safety, the computerised unit dose drug dispensing system was introduced in the Ruppiner Kliniken in 2009. The implementation of the system to the clinic was scientifically evaluated within the scope of a diploma thesis which focused on the examination and analysis of medication safety and its evolvement. Amongst others, medication errors were detected and classified (via DokuPIK). The thesis showed that the implementation of the computerised unit dose system had a positive impact on the reduction of consequences of common and clinically relevant medication errors, thereby enhancing medication safety for the patient.

  11. Use of and attitudes to a hospital information system by medical secretaries, nurses and physicians deprived of the paper-based medical record: a case report.

    PubMed

    Laerum, Hallvard; Karlsen, Tom H; Faxvaag, Arild

    2004-10-16

    Most hospitals keep and update their paper-based medical records after introducing an electronic medical record or a hospital information system (HIS). This case report describes a HIS in a hospital where the paper-based medical records are scanned and eliminated. To evaluate the HIS comprehensively, the perspectives of medical secretaries and nurses are described as well as that of physicians. We have used questionnaires and interviews to assess and compare frequency of use of the HIS for essential tasks, task performance and user satisfaction among medical secretaries, nurses and physicians. The medical secretaries use the HIS much more than the nurses and the physicians, and they consider that the electronic HIS greatly has simplified their work. The work of nurses and physicians has also become simplified, but they find less satisfaction with the system, particularly with the use of scanned document images. Although the basis for reference is limited, the results support the assertion that replacing the paper-based medical record primarily benefits the medical secretaries, and to a lesser degree the nurses and the physicians. The varying results in the different employee groups emphasize the need for a multidisciplinary approach when evaluating a HIS.

  12. Room transfers and the risk of delirium incidence amongst hospitalized elderly medical patients: a case-control study.

    PubMed

    Goldberg, Amanda; Straus, Sharon E; Hamid, Jemila S; Wong, Camilla L

    2015-06-25

    Room transfers are suspected to promote the development of delirium in hospitalized elderly patients, but no studies have systematically examined the relationship between room transfers and delirium incidence. We used a case-control study to determine if the number of room transfers per patient days is associated with an increased incidence of delirium amongst hospitalized elderly medical patients, controlling for baseline risk factors. We included patients 70 years of age or older who were admitted to the internal medicine or geriatric medicine services at St. Michael's Hospital between October 2009 and September 2010 for more than 24 h. The cases consisted of patients who developed delirium during the first week of hospital stay. The controls consisted of patients who did not develop delirium during the first week of hospital stay. Patients with evidence of delirium at admission were excluded from the analysis. A multivariable logistic regression model was used to determine the relationship between room transfers and delirium development within the first week of hospital stay. 994 patients were included in the study, of which 126 developed delirium during the first week of hospital stay. Using a multivariable logistic regression model which controlled for age, gender, cognitive impairment, vision impairment, dehydration, and severe illness, room transfers per patient days were associated with delirium incidence (OR: 9.69, 95 % CI (6.20 to15.16), P < 0.0001). An increased number of room transfers per patient days is associated with an increased incidence of delirium amongst hospitalized elderly medical patients. This is an exploratory analysis and needs confirmation with larger studies.

  13. Managerial procedures and hospital practices: a case study of the development of a new medical discipline.

    PubMed

    Cabridain, M O

    1985-01-01

    In anesthésie-réanimation, a discipline that brings together anaesthesiology and emergency as well as intensive care, the managerial methods of evaluation and control of needs in personnel, were not adequate for describing medical practices. Around four managerial standards that were used by the Paris public hospital administration, new situations have crystalized. The historical analysis of how these standards have been put into use, used and put in question throws light upon the way organizations function. The present day situation in this speciality seems to be mainly determined by the strategies of specialists for obtaining professional recognition of their discipline and for advancing their careers.

  14. Supporting management of medical equipment for inpatient service in public hospitals: a case study.

    PubMed

    Figueroa, Rosa L; Vallejos, Guido E

    2013-01-01

    This work presents a study of medical equipment availability in the short and long term. The work is divided in two parts. The first part is an analysis of the medical equipment inventory for the institution of study. We consider the replacement, maintenance, and reinforcement of the available medical equipment by considering local guidelines and surveying clinical personnel appreciation. The resulting recommendation is to upgrade the current equipment inventory if necessary. The second part considered a demand analysis in the short and medium term. We predicted the future demand with a 5-year horizon using Holt-Winters models. Inventory analysis showed that 27% of the medical equipment in stock was not functional. Due to this poor performance result we suggested that the hospital gradually addresses this situation by replacing 29 non-functional equipment items, reinforcing stock with 40 new items, and adding 11 items not available in the inventory but suggested by the national guidelines. The results suggest that general medicine inpatient demand has a tendency to increase within the time e.g. for general medicine inpatient service the highest increment is obtained by respiratory (12%, RMSE=8%) and genitourinary diseases (20%, RMSE=9%). This increment did not involve any further upgrading of the proposed inventory.

  15. [Investigation of the hepatitis E virus seroprevalence in cases admitted to Hacettepe University Medical Faculty Hospital].

    PubMed

    Aydın, Nesibe Nur; Ergünay, Koray; Karagül, Aydan; Pınar, Ahmet; Us, Dürdal

    2015-10-01

    Hepatitis E virus (HEV), classified in Hepeviridae family, Hepevirus genus, is a non-enveloped virus with icosahedral capsid containing single-stranded positive sense RNA genome. HEV infections may be asymptomatic especially in children, however it may present as fulminant hepatitis in pregnant women, as well as chronic hepatitis in immunocompromised patients. There are four well-known genotypes of HEV that infect humans and many mammalian species. Genotype 1 and 2 are frequently responsible for water-borne infections transmitted by fecal-oral way in developing countries, while genotype 3 and 4 cause zoonotic infections in developed countries. Turkey is considered as an endemic country with a total seroprevalence rate of 6.3% for normal population, showing significant variation (0-73%) according to the regions and study groups. The aims of this study were to investigate the HEV seropositivity in cases admitted to Hacettepe University Medical Faculty Hospital (HUMFH), to evaluate the results according to the demographic features of patients, and to determine the current HEV seroprevalence in our region, contributing seroepidemiological data in Turkey. A total of 1043 serum samples (514 female, 529 male; age range: 1-90 years, mean age: 38.03) obtained from 327 blood donors (32 female, 295 male; age range: 19-59 years, mean age: 31.1) who were admitted to HUMFH Blood Center, and 716 sera (482 female, 234 male; age range: 1-90 years, mean age: 41.7) that were sent to HUMFH Central Laboratory from various outpatient/inpatient clinics, between November 2012 to November 2013, were included in the study. The presence of HEV-IgG antibodies in serum samples was detected by a commercial ELISA method (Euroimmun, Germany), and the presence of HEV-IgM antibodies was also investigated in the sera with IgG-positive results. The overall HEV-IgG seropositivity rate was determined as 4.4% (46/1043), and the seropositivity rates for blood donors and in/outpatients were as 0.92% (3

  16. Short Text Messages (SMS) as an Additional Tool for Notifying Medical Staff in Case of a Hospital Mass Casualty Incident.

    PubMed

    Timler, Dariusz; Bogusiak, Katarzyna; Kasielska-Trojan, Anna; Neskoromna-Jędrzejczak, Aneta; Gałązkowski, Robert; Szarpak, Łukasz

    2016-02-01

    The aim of the study was to verify the effectiveness of short text messages (short message service, or SMS) as an additional notification tool in case of fire or a mass casualty incident in a hospital. A total of 2242 SMS text messages were sent to 59 hospital workers divided into 3 groups (n=21, n=19, n=19). Messages were sent from a Samsung GT-S8500 Wave cell phone and Orange Poland was chosen as the telecommunication provider. During a 3-month trial period, messages were sent between 3:35 PM and midnight with no regular pattern. Employees were asked to respond by telling how much time it would take them to reach the hospital in case of a mass casualty incident. The mean reaction time (SMS reply) was 36.41 minutes. The mean declared time of arrival to the hospital was 100.5 minutes. After excluding 10% of extreme values for declared arrival time, the mean arrival time was estimated as 38.35 minutes. Short text messages (SMS) can be considered an additional tool for notifying medical staff in case of a mass casualty incident.

  17. [New medical approach to out-of-hospital treatment of psychomotor agitation in psychiatric patients: a report of 14 cases].

    PubMed

    Cester-Martínez, Armando; Cortés-Ramas, José Antonio; Borraz-Clares, Diego; Pellicer-Gayarre, Marta

    2017-06-01

    This case series explored the usefulness of an inhaled dose of 9.1 mg of loxapine administered outside the hospital to treat psychomotor agitation related to schizophrenia, bipolar disorder, or schizoaffective disorder. The Clinical Global Impression Scale and the Positive and Negative Syndrome Scale (excitement component) were used to assess the effects of treatment in 14 patients. The treatment was useful in 12 patients, who showed significant improvement (P<.001) after inhalation. We conclude that inhaled loxapine is useful for treating out-of-hospital psychomotor agitation related to a psychiatric disorder. Mechanical restraint and parenteral medication can be avoided after use of this drug. Loxapine treatment shortens the agitation episode and attenuates the impact on the patient, facilitating ambulance transfer.

  18. [Forensic medical diagnostics of intoxication with certain poisonous mushrooms in the case of the lethal outcome in a hospital].

    PubMed

    Zaraf'aynts, G N

    2016-01-01

    The present study was undertaken with a view to improving forensic medical diagnostics of intoxication with poisonous mushrooms in the cases of patients' death in a hospital. A total of 15 protocols of forensic medical examination of the corpses of the people who had died from acute poisoning were available for the analysis. The deathly toxins were amanitin and muscarine contained in various combinations in the death cap (Amanita phalloides) and the early false morels (Gyromitra esculenta and G. gigas). The main poisoning season in the former case was May and in the latter case August and September (93.4%). The mortality rate in the case of group intoxication (such cases accounted for 40% of the total) amounted to 28.6%. 40% of the deceased subjects consumed mushrooms together with alcohol. The poisoning caused the development of either phalloidin- or gyromitrin-intoxication syndromes (after consumption of Amanita phalloides and Gyromitra esculenta respectively). It is emphasized that the forensic medical experts must substantiate the diagnosis of poisoning with mushroom toxins based on the results of the chemical-toxicological and/or forensic chemical investigations. The relevant materials taken from the victim or the corpse should be dispatched for analysis not only within the first day but also on days 2-4 after intoxication. The mycological and genetic analysis must include the detection and identification of mushroom microparticles and spores in the smears from the oral cavity, vomiting matter, wash water, gastric and intestinal contents. In addition, the macro- and microscopic morphological signs, clinical data (major syndromes, results of laboratory studies, methods of treatment) should be taken into consideration as well as the time (season) of mushroom gathering, simultaneous poisoning in a group of people, and other pertinent information.

  19. Medication safety during your hospital stay

    MedlinePlus

    Five-rights - medication; Medication administration - hospital; Medical errors - medication; Patient safety - medication safety ... right dose, at the right times. During your hospital stay, your health care team needs to follow ...

  20. Management of medical technology: case study of a major acute hospital.

    PubMed

    Brown, Ian; Smale, Andrew

    2007-01-01

    This paper presents results of a Capital Equipment Management Plan undertaken at a major acute hospital in Australia. By classifying existing equipment using a threshold replacement value into Major and Minor items, detailed planning information was collected for 527 items of Major equipment representing 80% of the hospital's total equipment stock. A number of meaningful views of this significant asset base are presented, and a prioritisation method used to provide recommendations for future equipment replacement and acquisition for a 5 year planning period. The survey work to identify and document actual equipment items provides a convincing argument for the funding levels required for capital equipment replacement and acquisition, and evidence for the extent of technology reliance in modern health care facilities.

  1. Direct Medical Cost of Influenza-Related Hospitalizations among Severe Acute Respiratory Infections Cases in Three Provinces in China

    PubMed Central

    Zhu, Xiaoping; Gao, Lidong; Li, Zhong; Feng, Ao; Jin, Hui; Wang, Shiyuan; Su, Qiru; Xu, Zhen; Feng, Zijian

    2013-01-01

    Background Influenza-related hospitalizations impose a considerable economic and social burden. This study aimed to better understand the economic burden of influenza-related hospitalizations among patients in China in different age and risk categories. Methods Laboratory-confirmed influenza-related hospitalizations between December 2009 and June 2011 from three hospitals participating in the Chinese Severe Acute Respiratory Infections (SARI) sentinel surveillance system were included in this study. Hospital billing data were collected from each hospital’s Hospital Information System (HIS) and divided into five cost categories. Demographic and clinical information was collected from medical records. Mean (range) and median (interquartile range [IQR]) costs were calculated and compared among children (≤15 years), adults (16–64 years) and elderly (≥65 years) groups. Factors influencing cost were analyzed. Results A total of 106 laboratory-confirmed influenza-related hospitalizations were identified, 60% of which were children. The mean (range) direct medical cost was $1,797 ($80–$27,545) for all hospitalizations, and the median (IQR) direct medical cost was $231 ($164), $854 ($890), and $2,263 ($7,803) for children, adults, and elderly, respectively. Therapeutics and diagnostics were the two largest components of direct medical cost, comprising 57% and 23%, respectively. Cost of physician services was the lowest at less than 1%. Conclusion Direct medical cost of influenza-related hospitalizations imposes a heavy burden on patients and their families in China. Further study is needed to provide more comprehensive evidence on the economic burden of influenza. Our study highlights the need to increase vaccination rate and develop targeted national preventive strategies. PMID:23717485

  2. Accreditation status of hospital pharmacies and their challenges of medication management: A case of south Iranian largest university

    PubMed Central

    Barati, Omid; Dorosti, Hesam; Talebzadeh, Alireza; Bastani, Peivand

    2016-01-01

    Considering the importance of accreditation for hospital pharmacies, this study was to determine the challenges of medication management in hospital pharmacies affiliated with Shiraz University of Medical Sciences, Iran. The study was a mix-method research conducted in two qualitative and quantitative phases during the years 2014–2015 in Shiraz, Iran. National Accreditation Standard checklist for hospitals was used for data collection in the first phase, and Delphi method was applied in three rounds to achieve the most challenges of medication management and the related solutions. Results indicated a medium status of accreditation for all three dimensions in the above hospital pharmacies (3.53, 42.15 and 7, respectively). Lack of clinical pharmacists, nonparticipation of the pharmacy director in annual budgeting, lack of access to patient information, discontinuity of pharmaceutical care for patients discharged, defects in pharmacy staff training, lack of legislation in support of pharmacists and lack of adequate access to physicians' prescriptions, shortages in reporting medication errors, and lack of evidence related to microbial contamination are the most challenges extracted from the second phase. It seems that the studied hospital pharmacies encounter numerous problems regarding accreditation, pharmaceutical care as well as appropriate medication management and supply chain. Attempts to solve these problems can play an important role in improving the efficiency and effectiveness of pharmacies in Iran. PMID:27429924

  3. Accreditation status of hospital pharmacies and their challenges of medication management: A case of south Iranian largest university.

    PubMed

    Barati, Omid; Dorosti, Hesam; Talebzadeh, Alireza; Bastani, Peivand

    2016-01-01

    Considering the importance of accreditation for hospital pharmacies, this study was to determine the challenges of medication management in hospital pharmacies affiliated with Shiraz University of Medical Sciences, Iran. The study was a mix-method research conducted in two qualitative and quantitative phases during the years 2014-2015 in Shiraz, Iran. National Accreditation Standard checklist for hospitals was used for data collection in the first phase, and Delphi method was applied in three rounds to achieve the most challenges of medication management and the related solutions. Results indicated a medium status of accreditation for all three dimensions in the above hospital pharmacies (3.53, 42.15 and 7, respectively). Lack of clinical pharmacists, nonparticipation of the pharmacy director in annual budgeting, lack of access to patient information, discontinuity of pharmaceutical care for patients discharged, defects in pharmacy staff training, lack of legislation in support of pharmacists and lack of adequate access to physicians' prescriptions, shortages in reporting medication errors, and lack of evidence related to microbial contamination are the most challenges extracted from the second phase. It seems that the studied hospital pharmacies encounter numerous problems regarding accreditation, pharmaceutical care as well as appropriate medication management and supply chain. Attempts to solve these problems can play an important role in improving the efficiency and effectiveness of pharmacies in Iran.

  4. [Medication errors and medication reconciliation from a hospital pharmacist's perspective].

    PubMed

    Amann, Steffen; Kantelhardt, Pamela

    2012-01-01

    To reduce medication errors and other drug-related problems, their systematic discovery, documentation and evaluation is essential. The web-based documentation database ADKA-DokuPIK enables both the documentation and the publication of annotated individual cases and, moreover, systematic errors or accumulations of risk drugs may be determined. Medication reconciliation is another important component to increase safety in drug therapy. Hospital pharmacists may support and significantly improve this process. In Germany some initial information from various projects is available. Medication reconciliation performed by hospital pharmacists may significantly increase the completeness and accuracy of medication regimens. Patient counselling together with the necessary drug supply at discharge improves patients' knowledge, closes supply gaps and improves the satisfaction of all parties.

  5. Medication errors: hospital pharmacist perspective.

    PubMed

    Guchelaar, Henk-Jan; Colen, Hadewig B B; Kalmeijer, Mathijs D; Hudson, Patrick T W; Teepe-Twiss, Irene M

    2005-01-01

    In recent years medication error has justly received considerable attention, as it causes substantial mortality, morbidity and additional healthcare costs. Risk assessment models, adapted from commercial aviation and the oil and gas industries, are currently being developed for use in clinical pharmacy. The hospital pharmacist is best placed to oversee the quality of the entire drug distribution chain, from prescribing, drug choice, dispensing and preparation to the administration of drugs, and can fulfil a vital role in improving medication safety. Most elements of the drug distribution chain can be optimised; however, because comparative intervention studies are scarce, there is little scientific evidence available demonstrating improvements in medication safety through such interventions. Possible interventions aimed at reducing medication errors, such as developing methods for detection of patients with increased risk of adverse drug events, performing risk assessment in clinical pharmacy and optimising the drug distribution chain are discussed. Moreover, the specific role of the clinical pharmacist in improving medication safety is highlighted, both at an organisational level and in individual patient care.

  6. [Decrease in hospitalizations due to polyvalent medical day hospital].

    PubMed

    Escobar, M A; García-Egido, A A; Carmona, R; Lucas, A; Márquez, C; Gómez, F

    2012-02-01

    The day hospital is an alternative to hospitalization. This alternative improves accessibility and comfort of the patients, and avoids hospitalizations. Nevertheless, the efficacy of the polyvalent medical day hospital in avoiding hospitalizations has not been evaluated. To analyze hospital stays avoided by the polyvalent medical day hospital of a university hospital of the Andalusian Health Service. An observational prospective study of the patients studied and/or treated in the polyvalent medical day hospital of the Hospital Universitario Puerto Real over a one year period. A total of 9640 patients were attended to, with 1413 procedures and 4921 i.v. treatments. There were 3182 visits to the priority consultation of the polyvalent medical day hospital. The most frequent consultation complaints were constitutional symptoms (15.9%) and anemia (14.5%). After the first visit, 21.5% of the patients were discharged and fewer than 3% were hospitalized. Hospitalization was avoided in 16.8% of the patients, there being a 6.0% decrease in the need for hospital beds (5.0% reduction in the internal medicine unit). Inadequate hospitalizations and 30-day readmissions decreased 93.3% and 4.2%, respectively. The most frequent diagnosis was neoplasm (26.0%), and most of the beds freed up were generated by patients diagnosed of neoplasm (26.7%). With this type of polyvalent medical day hospital, we have observed improved efficiency of health care, freeing up hospital beds by reducing hospitalizations, inadequate hospitalizations and re-admissions in the medical units involved. Copyright © 2011 Elsevier España, S.L. All rights reserved.

  7. Medical tourism private hospitals: focus India.

    PubMed

    Brotman, Billie Ann

    2010-01-01

    This article examines demand factors for sophisticated medical treatments offered by private hospitals operating in India. Three types of medical tourism exist: Outbound, Inbound, and Intrabound. Increased profitability and positive growth trends by private hospital chains can be attributed to rising domestic income levels within India. Not all of the chains examined were financially solvent. Some of the hospital groups in this sample that advertised directly to potential Inbound medical tourists appear to be experiencing negative cash flows.

  8. Strategic management of Public Hospitals' medical services.

    PubMed

    Hao, Aimin; Yi, Tao; Li, Xia; Wei, Lei; Huang, Pei; Xu, Xinzhou; Yi, Lihua

    2016-01-01

    Purpose: The quality of medical services provided by competing public hospitals is the primary consideration of the public in determining the selection of a specific hospital for treatment. The main objective of strategic planning is to improve the quality of public hospital medical services. This paper provides an introduction to the history, significance, principles and practices of public hospital medical service strategy, as well as advancing the opinion that public hospital service strategy must not merely aim to produce but actually result in the highest possible level of quality, convenience, efficiency and patient satisfaction.

  9. Rotavirus Vaccine Cut Kids' Hospitalization, Medical Costs

    MedlinePlus

    ... fullstory_167720.html Rotavirus Vaccine Cut Kids' Hospitalization, Medical Costs Virus a common cause of diarrhea among ... a savings of more than $1 billion in medical costs, the researchers added. Rotavirus is a common ...

  10. Economic regulation and hospital behavior: the effects on medical staff organization and hospital-physician relationships.

    PubMed Central

    Shortell, S M; Morrisey, M A; Conrad, D A

    1985-01-01

    New forms of payment, growing competition, the continued evolution of multiunit hospital systems, and associated forces are redefining the fundamental relationship between hospitals and physicians. As part of a larger theory of organizational response to the environment, the effects of these external forces on hospital-medical staff organization were examined using both cross-sectional data and data collected at two points in time. Findings suggest that regulation and competition, at least up to 1982, have had relatively little direct effect on hospital medical staff organization. Rather, changes in medical staff organization are more strongly associated with hospital case mix and with structural characteristics involving membership in a multiunit system, size, ownership, and location. The pervasive effect of case mix and the consistent effect of multiunit system involvement support the need for policymakers to give these factors particular attention in considering how hospitals and their medical staffs might respond to future regulatory and/or competitive approaches. PMID:3936822

  11. Hospital Contracts: Important Issues for Medical Groups.

    PubMed

    Rosolio, Charles E

    2016-01-01

    Relationships with hospitals and outpatient medical facilities have always been an important part of the business model for private medical practices. As healthcare delivery to patients has evolved in the United States (much of it driven by the new government mandates, regulations, and the Affordable Care Act), the delivery of such services is becoming more and more centered on the hospital or institutional setting, thus making contractual relationships with hospitals even more important for medical practices. As a natural outgrowth of this relationship, attention to hospital contracts is becoming more important.

  12. Measuring hospital medical staff organizational structure.

    PubMed Central

    Shortell, S M; Getzen, T E

    1979-01-01

    Based on organization theory and the work of Roemer and Friedman, seven dimensions of hospital medical staff organization structure are proposed and examined. The data are based on a 1973 nationwide survey of hospital medical staffs conducted by the American Hospital Association. Factor analysis yielded six relatively independent dimensions supporting a multidimensional view of medical staff organization structure. The six dimensions include 1) Resource Capability, 2) Generalist Physician Contractual Orientation, 3) Communication/Control, 4) Local Staff Orientation, 5) Participation in Decision Making, and 6) Hospital-Based Physician Contractual Orientation. It is suggested that these dimensions can be used to develop an empirical typology of hospital medical staff organization structure and to investigate the relationship between medical staff organization and public policy issues related to cost containment and quality assurance. PMID:511580

  13. Effectiveness of acute geriatric units on functional decline, living at home, and case fatality among older patients admitted to hospital for acute medical disorders: meta-analysis

    PubMed Central

    Suárez-García, Francisco M; López-Arrieta, Jesús; Rodríguez-Mañas, Leocadio; Rodríguez-Artalejo, Fernando

    2009-01-01

    Objective To assess the effectiveness of acute geriatric units compared with conventional care units in adults aged 65 or more admitted to hospital for acute medical disorders. Design Systematic review and meta-analysis. Data sources Medline, Embase, and the Cochrane Library up to 31 August 2008, and references from published literature. Review methods Randomised trials, non-randomised trials, and case-control studies were included. Exclusions were studies based on administrative databases, those that assessed care for a single disorder, those that evaluated acute and subacute care units, and those in which patients were admitted to the acute geriatric unit after three or more days of being admitted to hospital. Two investigators independently selected the studies and extracted the data. Results 11 studies were included of which five were randomised trials, four non-randomised trials, and two case-control studies. The randomised trials showed that compared with older people admitted to conventional care units those admitted to acute geriatric units had a lower risk of functional decline at discharge (combined odds ratio 0.82, 95% confidence interval 0.68 to 0.99) and were more likely to live at home after discharge (1.30, 1.11 to 1.52), with no differences in case fatality (0.83, 0.60 to 1.14). The global analysis of all studies, including non-randomised trials, showed similar results. Conclusions Care of people aged 65 or more with acute medical disorders in acute geriatric units produces a functional benefit compared with conventional hospital care, and increases the likelihood of living at home after discharge. PMID:19164393

  14. Variation between Hospitals with Regard to Diagnostic Practice, Coding Accuracy, and Case-Mix. A Retrospective Validation Study of Administrative Data versus Medical Records for Estimating 30-Day Mortality after Hip Fracture

    PubMed Central

    Kristoffersen, Doris Tove; Skyrud, Katrine Damgaard; Lindman, Anja Schou

    2016-01-01

    Background The purpose of this study was to assess the validity of patient administrative data (PAS) for calculating 30-day mortality after hip fracture as a quality indicator, by a retrospective study of medical records. Methods We used PAS data from all Norwegian hospitals (2005–2009), merged with vital status from the National Registry, to calculate 30-day case-mix adjusted mortality for each hospital (n = 51). We used stratified sampling to establish a representative sample of both hospitals and cases. The hospitals were stratified according to high, low and medium mortality of which 4, 3, and 5 hospitals were sampled, respectively. Within hospitals, cases were sampled stratified according to year of admission, age, length of stay, and vital 30-day status (alive/dead). The final study sample included 1043 cases from 11 hospitals. Clinical information was abstracted from the medical records. Diagnostic and clinical information from the medical records and PAS were used to define definite and probable hip fracture. We used logistic regression analysis in order to estimate systematic between-hospital variation in unmeasured confounding. Finally, to study the consequences of unmeasured confounding for identifying mortality outlier hospitals, a sensitivity analysis was performed. Results The estimated overall positive predictive value was 95.9% for definite and 99.7% for definite or probable hip fracture, with no statistically significant differences between hospitals. The standard deviation of the additional, systematic hospital bias in mortality estimates was 0.044 on the logistic scale. The effect of unmeasured confounding on outlier detection was small to moderate, noticeable only for large hospital volumes. Conclusions This study showed that PAS data are adequate for identifying cases of hip fracture, and the effect of unmeasured case mix variation was small. In conclusion, PAS data are adequate for calculating 30-day mortality after hip-fracture as a quality

  15. The impact of medical insurance policies on the hospitalization services utilization of people with schizophrenia: A case study in Changsha, China.

    PubMed

    Feng, Yi; Xiong, Xianjun; Xue, Qiuji; Yao, Lan; Luo, Fei; Xiang, Li

    2013-05-01

    To evaluate the impact of two medical insurers' policies on the hospitalization of people with schizophrenia and the economic burden they faced during a period of rapid health services reform in China. A comparative analysis was made of Urban Employee-Basic Medical Insurance (UE-BMI) and Urban Residents-Basic Medical Insurance (UR-BMI) policies on the medical management of schizophrenics, and was compared with hospitalization expenses, insurer reimbursement data and other information collected from the HMO (health maintenance organization) and social insurance agencies on the care of people with schizophrenia in Changsha in 2010. In-depth interviews were also conducted with relevant managers. Compared with inpatients covered by UR-BMI, the inpatients of UE-BMI were admitted to higher level medical institutions and were prescribed expensive second generation antipsychotics (SGA) medicines. Nevertheless, the hospitalization service utilization and cost of inpatients' hospitalization under UE-BMI were far less than that of inpatients under UR-BMI. The insurance level difference between two medical insurance schemes influences the treatment regimens and benefits received by patients. Furthermore, the integration of schizophrenia management into the outpatient services pooling fund for special diseases(OS-PFSD) can appropriately reduce hospitalization utilization, which, together with the payment way reform and the prescription of reasonable medications, can significantly reduce the overall hospitalization cost for patients.

  16. Dispatchers impression plus Medical Priority Dispatch System reduced dispatch centre times in cases of out of hospital cardiac arrest. Pre-alert--a prospective, cluster randomized trial.

    PubMed

    Weiser, Christoph; van Tulder, Raphael; Stöckl, Mathias; Schober, Andreas; Herkner, Harald; Chwojka, Christof C; Hopfgartner, Alexander; Novosad, Heinz; Schreiber, Wolfgang; Sterz, Fritz

    2013-07-01

    Dispatch centre processing times for out-of-hospital cardiac arrest or critically ill patients should be as short as possible. A modified 'pre-alert' dispatch workflow might be able to improve the processing time. Between October 2010 and May 2011 dispatch events, suspicious for cardiac arrest, were prospectively randomized in 24h clusters. The emergency medical service of the intervention group got, based on the dispatchers impression, a 'pre-alert' alarm-message followed by the standard Medical Priority Dispatch System query whereas the control group did not. In 225 clusters 1500 events were eligible for analysis. Data are presented as median and 25-75 interquartile ranges. Per-protocol analysis demonstrated for the intervention group on 'pre-alert' days a median processing time of 143 s (109-187; n=256) versus 198 s (167-255; n=502) in the control group on non 'pre-alert' days, with a difference of 0.23 log-seconds (p<0.001; 95% CI 0.74-0.28). In critical ill patients, intention-to-treat analysis showed for the intervention group a median of 168 s (131-264; n=153) versus 239 s (176-309; n=164) in the control group, with a difference of 1.4 log-seconds (p<0.001; 95% CI 1.25-1.55). Dispatch times can effectively be reduced in cases of out-of-hospital cardiac arrest or critical ill patients with a 'pre-alert' dispatch workflow in combination with the Medical Priority Dispatch System protocol. This might play an important role in improving patient care. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  17. A qualitative framework to assess hospital / medical websites.

    PubMed

    Rafe, Vahid; Monfaredzadeh, Maryam

    2012-10-01

    Nowadays, there are many peoples who access to the internet to search for a proper hospital with their desired medical services. Hence, the website quality of hospitals or medical centers is very important to help patients/users. However, to design high qualitative medical websites, we should first know the medical quality metrics. Then, we should try to find a way to assess different medical websites based on the quality metrics. In fact, medical websites may have a significant role to increase the society's knowledge about people health, provided services for patients etc. Thus, it is necessary to design a framework to evaluate the quality of these websites. Even though there are many medical websites, unfortunately, there are a few studies about quality analysis of medical/hospital websites. In this paper, we propose a qualitative framework to assess different medical websites. The proposed framework consists of 7 main categories, each having different metrics. Finally, to show how these metrics can help designers to assess the websites quality, we have considered 3 different hospitals as case studies. We asked different people including doctors, website designers, and usual peoples to evaluate our defined metrics on each case study. At the end, the results are shown through different charts.

  18. [Outplacement of medical students in local hospitals].

    PubMed

    Lindsetmo, R O; Fosse, L; Evensen, S A; Wyller, V B; Nylehn, P; Ogreid, D

    1998-02-28

    The organisation and content of the training of medical students in practical and clinical skills at Norwegian universities is presented and discussed. Based on experience from Tromsø University, an increased use of local hospitals for training medical students in practical and clinical skills is planned for all universities in Norway.

  19. Implementing Medical Teaching Policy in University Hospitals

    ERIC Educational Resources Information Center

    Engbers, Rik; Fluit, Cornelia Cornelia R. M. G.; Bolhuis, Sanneke; de Visser, Marieke; Laan, Roland F. J. M.

    2017-01-01

    Within the unique and complex settings of university hospitals, it is difficult to implement policy initiatives aimed at developing careers in and improving the quality of academic medical teaching because of the competing domains of medical research and patient care. Factors that influence faculty in making use of teaching policy incentives have…

  20. [Thromboembolic prophylaxis in hospitalized medical patients].

    PubMed

    Braekkan, Sigrid; Grimsgaard, Sameline; Hansen, John-Bjarne

    2007-05-03

    The risk of venous thromboembolism (VTE) ranges between 15 and 40% for patients hospitalized for certain medical conditions. Clinical studies have shown that prophylactic treatment with low molecular weight heparins (LMWH) reduces the risk of VTE from 15 to 6%. The aim of this study was to evaluate the use of thromboprophylaxis among hospitalized medical patients after the introduction of clinical guidelines. A retrospective chart review was conducted among patients hospitalized for pneumonia, chronic obstructive pulmonary disease (COPD) and heart failure at Tromsø University Hospital during 2000-2001 and 2003-2004, i.e. before and after introduction of guidelines for thromboprophylaxis. Demographic data, risk factors for VTE and use of thromboprophylaxis were recorded. 434 hospitalizations were included. According to the guidelines, prophylaxis was indicated in 307 (71%) hospitalizations, and LMWH was prescribed in 62 (20%) hospitalizations. There was a non-significant increase in the use of prophylaxis from 18% to 23% after the introduction of clinical guidelines (p = 0.3). Acute myocardial infarction, acute infection and immobilization were significant predictors for prophylaxis. This study indicates insufficient adherence to clinical guidelines for thromboprophylaxis to patients at risk of VTE in internal medicine. There is potential for improvement of prophylactic treatment to avoid serious VTE among hospitalized medical patients.

  1. Impact of natural disaster combined with nuclear power plant accidents on local medical services: a case study of Minamisoma Municipal General Hospital after the Great East Japan Earthquake.

    PubMed

    Kodama, Yuko; Oikawa, Tomoyoshi; Hayashi, Kaoru; Takano, Michiko; Nagano, Mayumi; Onoda, Katsuko; Yoshida, Toshiharu; Takada, Akemi; Hanai, Tatsuo; Shimada, Shunji; Shimada, Satoko; Nishiuchi, Yasuyuki; Onoda, Syuichi; Monma, Kazuo; Tsubokura, Masaharu; Matsumura, Tomoko; Kami, Masahiro; Kanazawa, Yukio

    2014-12-01

    To elucidate the impacts of nuclear plant accidents on neighboring medical centers, we investigated the operations of our hospital within the first 10 days of the Great East Japan Earthquake followed by the Fukushima Daiichi nuclear power plant accident. Data were extracted from medical records and hospital administrative records covering 11 to 20 March 2011. Factual information on the disaster was obtained from public access media. A total of 622 outpatients and 241 inpatients were treated. Outpatients included 43 injured, 6 with cardiopulmonary arrest, and 573 with chronic diseases. Among the 241 inpatients, 5 died, 137 were discharged, and the other 99 were transferred to other hospitals. No communication methods or medical or food supplies were available for 4 days after the earthquake. Hospital directors allowed employees to leave the hospital on day 4. All 39 temporary workers were evacuated immediately, and 71 of 239 full-time employees remained. These employees handled extra tasks besides patient care and patient transfer to other hospitals. Committed effective doses indicating the magnitude of health risks due to an intake of radioactive cesium into the human body were found to be minimal according to internal radiation exposure screening carried out from July to August 2011. After the disaster, hospitals located within the evacuation zone of a 30-km radius of the nuclear power plant were isolated. Maintenance of the health care system in such an event becomes difficult.

  2. Implementing medical teaching policy in university hospitals.

    PubMed

    Engbers, Rik; Fluit, Cornelia R M G; Bolhuis, Sanneke; de Visser, Marieke; Laan, Roland F J M

    2016-11-16

    Within the unique and complex settings of university hospitals, it is difficult to implement policy initiatives aimed at developing careers in and improving the quality of academic medical teaching because of the competing domains of medical research and patient care. Factors that influence faculty in making use of teaching policy incentives have remained underexplored. Knowledge of these factors is needed to develop theory on the successful implementation of medical teaching policy in university hospitals. To explore factors that influence faculty in making use of teaching policy incentives and to develop a conceptual model for implementation of medical teaching policy in university hospitals. We used the grounded theory methodology. We applied constant comparative analysis to qualitative data obtained from 12 semi-structured interviews conducted at the Radboud University Medical Center. We used a constructivist approach, in which data and theories are co-created through interaction between the researcher and the field and its participants. We constructed a model for the implementation of medical teaching policy in university hospitals, including five factors that were perceived to promote or inhibit faculty in a university hospital to make use of teaching policy incentives: Executive Board Strategy, Departmental Strategy, Departmental Structure, Departmental Culture, and Individual Strategy. Most factors we found to affect individual teachers' strategies and their use of medical teaching policy lie at the departmental level. If an individual teacher's strategy is focused on medical teaching and a medical teaching career, and the departmental context offers support and opportunity for his/her development, this promotes faculty's use of teaching policy incentives.

  3. [Suggestions for buying medical equipment in hospitals].

    PubMed

    Trontzos, Christos

    2004-01-01

    TO THE EDITOR: Both in Greece and in other European countries there are plans to buy more medical equipment. If the whole procedure is not effective, it may result to a large deficit in the hospital budget. The total hospital deficit now in Greece is about 2.5 billion euros. It is suggested that in every hospital, the Authorized Committee for Medical Equipment Purchasing, should include the following: One Director of a Medical Department related to the equipment to be bought and another Director of a Medical Department, unrelated. One accountant. One legal advisor specialized in hospital affairs. One economical advisor specialized in banking who will be able to suggest leasing or other means of financing the purchase of the relevant equipment. A cost accounting analysis described by a detailed report, should be provided to secure that the equipment to be bought should be cost-effective and leaving a reasonable surplus after not more than 10 years from the time it is installed. Finally, the possibility of using one expensive equipment to cover the needs of more than one hospitals either by moving the equipment (i.e. the PET/CT camera by a large vehicle) or by transferring the patients to a central hospital, may be provided by the above Authorized Committee.

  4. Television documentaries lifting hospital, medical center profiles.

    PubMed

    Rees, T

    2001-01-01

    The nation's hospitals and medical centers are enjoying the legacy of TV audiences' addiction to medical dramas. Cable television has met the challenge with documentary coverage of real live hospitals. The medium offers many benefits and few disadvantages for those marketing managers with the courage to welcome camera crews. Lynn Hopkins Cantwell is director of public relations and marketing for Children's National Medical Center, Washington, D.C., which was covered in a seven-instrument "Lifeline" documentary for the Discovery Channel. James G. Gosky is director of communications for The MetroHealth System, Cleveland, which was the subject of two installments of "Trauma: Life in th ER," produced for the Learning Channel. These marketing pros describe the myriad details they faced when their respective hospitals went "on camera." Among the key factors were good communications with all constituents, attention to detail, and follow-up.

  5. Jackson Park Hospital Green Building Medical Center

    SciTech Connect

    Dorsey, William; Vasquez, Nelson

    2010-05-01

    Jackson Park Hospital completed the construction of a new Medical Office Building on its campus this spring. The new building construction has adopted the City of Chicago's recent focus on protecting the environment, and conserving energy and resources, with the introduction of green building codes. Located in a poor, inner city neighborhood on the South side of Chicago, Jackson Park Hospital has chosen green building strategies to help make the area a better place to live and work.

  6. A retrospective study of cases presenting with chilblains (Perniosis) in Out Patient Department Of Dermatology, Nepal Medical College and Teaching Hospital (NMCTH).

    PubMed

    Pramanik, T; Jha, A K; Ghimire, A

    2011-09-01

    Chilblains (Perniosis/Pernio) is characterized by painful red-to-purple papular lesions involving the fingers or toes due to non-freezing damp cold that resolves with symptomatic treatment. As in winters, cold is moderate to severe in Kathmandu, this retrospective study was undertaken to find out the incidence of chilblains cases, seeking health care in the Out Patient Department of Dermatology, Nepal Medical College and Teaching Hospital. Cases of chilblains were noted in the months of October to December 2009, January to March 2010, October to December 2010 and January to March 2011. Out of total 49 cases maximum patients (n=25; male 10, female 15) were in the age group of 7-20 years. Rest of them (n=18; male 7, female 11) were in the age group of 21-40 years and only 6 (male 2, female 4) were in the age group of 41-65 years. Amongst all the cases 30 patients were females (61.2%) and 19 were males (38.8%). Most of (79.6%) the chilblain victims sought health care during the months of December to February -- coldest time of the years. The patients were advised to protect their acral parts from cold exposure as far as practicable by wearing shocks and gloves. They were advised not to warm their extremities all on a sudden, after exposure to cold, as this causes vasospasm and makes the condition worse. Extremities should be warmed gradually. Assessing the severity of the condition topical allocation of steroid ointment and/or anti allergic drugs was prescribed, when felt needed.

  7. Costs of venous thromboembolism associated with hospitalization for medical illness.

    PubMed

    Cohoon, Kevin P; Leibson, Cynthia L; Ransom, Jeanine E; Ashrani, Aneel A; Petterson, Tanya M; Long, Kirsten Hall; Bailey, Kent R; Heit, Johm A

    2015-04-01

    To determine population-based estimates of medical costs attributable to venous thromboembolism (VTE) among patients currently or recently hospitalized for acute medical illness. Population-based cohort study conducted in Olmsted County, Minnesota. Using Rochester Epidemiology Project (REP) resources, we identified all Olmsted County residents with objectively diagnosed incident VTE during or within 92 days of hospitalization for acute medical illness over the 18-year period of 1988 to 2005 (n=286). One Olmsted County resident hospitalized for medical illness without VTE was matched to each case for event date (±1 year), duration of prior medical history, and active cancer status. Subjects were followed forward in REP provider-linked billing data for standardized, inflation-adjusted direct medical costs (excluding outpatient pharmaceutical costs) from 1 year before their respective event or index date to the earliest of death, emigration from Olmsted County, or December 31, 2011 (study end date). We censored follow-up such that each case and matched control had similar periods of observation. We used generalized linear modeling (controlling for age, sex, preexisting conditions, and costs 1 year before index) to predict costs for cases and controls. Adjusted mean predicted costs were 2.5-fold higher for cases ($62,838) than for controls ($24,464) (P<.001) from index to up to 5 years post index. Cost differences between cases and controls were greatest within the first 3 months after the event date (mean difference=$16,897) but costs remained significantly higher for cases compared with controls for up to 3 years. VTE during or after recent hospitalization for medical illness contributes a substantial economic burden.

  8. Costs of Venous Thromboembolism Associated with Hospitalization for Medical Illness

    PubMed Central

    Cohoon, Kevin P.; Leibson, Cynthia L.; Ransom, Jeanine E.; Ashrani, Aneel A.; Petterson, Tanya M.; Long, Kirsten Hall; Bailey, Kent R.; Heit, John A.

    2015-01-01

    Objective To determine population-based estimates of medical costs attributable to venous thromboembolism (VTE) among patients currently or recently hospitalized for acute medical illness. Study Design Population-based cohort study conducted in Olmsted County, Minn. Methods Using Rochester Epidemiology Project (REP) resources, we identified all Olmsted County, MN residents with objectively-diagnosed incident VTE within 92 days of hospitalization for acute medical illness over the 18-year period, 1988–2005 (n=286). One Olmsted County resident hospitalized for medical illness without VTE was matched to each case on event date (± 1 year), duration of prior medical history and active cancer status. Subjects were followed forward in REP provider-linked billing data for standardized, inflation-adjusted direct medical costs (excluding outpatient pharmaceutical costs) from 1 year before their respective event or index date to the earliest of death, emigration from Olmsted County, or 12/31/2011 (study end date). We censored follow-up such that each case and match control had similar periods of observation. We also controlled for length of follow-up from index to up to 5-years post-index. We used generalized linear modeling (controlling for age, sex, pre-existing conditions and costs 1 year before index) to predict costs for cases and controls. Results Adjusted mean predicted costs were 2.5-fold higher for cases ($62,838) than for controls ($24,464) (P=<0.001) from index to up to 5-years post-index. Cost differences between cases and controls were greatest within the first 3 months after the event date (mean difference=$16,897) but costs remained significantly higher for cases compared to controls for up to 3 years. Conclusions VTE during or after recent hospitalization for medical illness contributes a substantial economic burden. PMID:26244788

  9. [Use of medication among hospital workers].

    PubMed

    Luz, Tatiana Chama Borges; Luiza, Vera Lucia; Avelar, Fernando Genovez; Hökerberg, Yara Hahr Marques; Passos, Sonia Regina Lambert

    2012-02-01

    Although medication is acknowledged as a key element in treating health problems, there is little information available on the use of medication by hospital workers. To estimate the prevalence and describe the patterns of medication consumption by hospital workers and to identify the factors associated with such consumption in this population, data from the "PROSEC" baseline cohort were analyzed (n=417). The prevalence of overall medication consumption was 72.4%, most of which was for nervous complaints (25.4%), especially analgesics (17.8%). Use of any amount of medication was independently associated with gender, number of medically diagnosed conditions and health problem in the two weeks prior to the interview. Use of a drug was significantly associated with income whereas self-diagnosed health problems were independently related with the use of two or more pharmaceutical products. The high prevalence of medication usage in this population, with analgesics being the most consumed medication, should be seen as a cause for concern, since many consumers are unaware that these products are not exempt from risk. Women and individuals in poor health are the main candidates for intervention programs in order to promote adequate and proper use of these pharmaceutical products.

  10. Recent outbreak of cutaneous anthrax in Bangladesh: clinico-demographic profile and treatment outcome of cases attended at Rajshahi Medical College Hospital

    PubMed Central

    2012-01-01

    Background Human cutaneous anthrax results from skin exposure to B. anthracis, primarily due to occupational exposure. Bangladesh has experienced a number of outbreaks of cutaneous anthrax in recent years. The last episode occurred from April to August, 2011 and created mass havoc due to its dreadful clinical outcome and socio-cultural consequences. We report here the clinico-demographic profile and treatment outcome of 15 cutaneous anthrax cases attended at the Dermatology Outpatient Department of Rajshahi Medical College Hospital, Bangladesh between April and August, 2011 with an aim to create awareness for early case detection and management. Findings Anthrax was suspected primarily based on cutaneous manifestations of typical non-tender ulcer with black eschar, with or without oedema, and a history of butchering, or dressing/washing of cattle/goat or their meat. Diagnosis was established by demonstration of large gram-positive rods, typically resembling B. anthracis under light microscope where possible and also by ascertaining therapeutic success. The mean age of cases was 21.4 years (ranging from 3 to 46 years), 7 (46.7%) being males and 8 (53.3%) females. The majority of cases were from lower middle socioeconomic status. Types of exposures included butchering (20%), contact with raw meat (46.7%), and live animals (33.3%). Malignant pustule was present in upper extremity, both extremities, face, and trunk at frequencies of 11 (73.3%), 2 (13.3%), 1 (6.7%) and 1 (6.7%) respectively. Eight (53.3%) patients presented with fever, 7 (46.7%) had localized oedema and 5 (33.3%) had regional lymphadenopathy. Anthrax was confirmed in 13 (86.7%) cases by demonstration of gram-positive rods. All cases were cured with 2 months oral ciprofloxacin combined with flucoxacillin for 2 weeks. Conclusions We present the findings from this series of cases to reinforce the criteria for clinical diagnosis and to urge prompt therapeutic measures to treat cutaneous anthrax

  11. [Medication errors in two Brazilian hospitals].

    PubMed

    Costa, L A; Loureiro, S; de Oliveira, M G G

    2006-01-01

    To determine medication errors in a public and in a private hospital. Cross-sectional. 638 dosis opportunities for errors (administered dosis + omitted dosis) were assessed in January, 2005. Medication error was defined as any given dose different from a legible prescription on patient chart. The error rate was calculated by the following equation: number of dosis/error opportunities. The errors were classified according to the categories: omission, unordered dose, extra-dose, wrong dose, wrong route, wrong form, wrong time. Out of 638 opportunities of error, 209 (32,9%) were wrong in some way. When wrong time errors were excluded, this rate decreased to 156 (25%). The most frequent types of errors were omission and unordered dosis, 67 (10,5%) and 65 (10,2%), respectively. There was no significant difference on the total error rate according to the type of hospital (public or private). The public hospital showed a double-fold unordered dose error rate as compared to the private hospital. Inversely, the private hospital showed a double-fold wrong time error rate than the public hospital.

  12. The realities and medical expense of hospitalization that originates in outpatient medicine treatment.

    PubMed

    Koinuma, Masayoshi; Yamanashi, Takahisa; Kamei, Miwako; Shiragami, Makoto

    2006-05-01

    Problems associated with outpatient pharmacotherapy may require hospitalization. However, such hospitalization may be prevented if pharmacist's pharmaceutical care (PC) is given. We investigated the reasons for hospitalization in medical institutions and medical expenses were calculated. Inpatient diagnoses, treatment, etc. in the previous year in the past were examined, and cases of hospitalization due to drug therapy were extracted. Next, the possibility of preventing hospitalization with PC practice was examined. Among 1552 cases, outpatient pharmacotherapy was the reason for hospitalization in 27 cases. Noncompliance was the underlying cause in about 40% of hospitalizations. It was thought that in 22 cases hospitalization could have been prevented by pharmacist's PC. The average hospitalization medical expense was 295,805 yen per patient. It is necessary to perform regular consultation recommendations, interventions with the family, home care, etc. for proactive PC.

  13. [The revised system of hospitalization for medical care and protection].

    PubMed

    Fukuo, Yasuhisa

    2014-01-01

    The Act to Partially Amend the Act on Mental Health and Welfare for the Mentally Disabled was passed on June 13, 2013. Major amendments regarding hospitalization for medical care and protection include the points listed below. The guardianship system will be abolished. Consent by a guardian will no longer be required in the case of hospitalization for medical care and protection. In the case of hospitalization for medical care and protection, the administrators of the psychiatric hospital are required to obtain the consent of one of the following persons: spouse, person with parental authority, person responsible for support, legal custodian, or curator. If no qualified person is available, consent must be obtained from the mayor, etc. of the municipality. The following three obligations are imposed on psychiatric hospital administrators. (1) Assignment of a person, such as a psychiatric social worker, to provide guidance and counseling to patients hospitalized for medical care and protection regarding their postdischarge living environment. (2) Collaboration with community support entities that consult with and provide information as necessary to the person hospitalized, their spouse, a person with parental authority, a person responsible for support, or their legal custodian or curator. (3) Organizational improvements to promote hospital discharge. With regard to requests for discharge, the revised law stipulates that, in addition to the person hospitalized with a mental disorder, others who may file a request for discharge with the psychiatric review board include: the person's spouse, a person with parental authority, a person responsible for support, or their legal custodian or curator. If none of the above persons are available, or if none of them are able to express their wishes, the mayor, etc. of the municipality having jurisdiction over the place of residence of the person hospitalized may request a discharge. In order to promote transition to life in the

  14. PREDICTIVE MODELING OF HOSPITAL READMISSION RATES USING ELECTRONIC MEDICAL RECORD-WIDE MACHINE LEARNING: A CASE-STUDY USING MOUNT SINAI HEART FAILURE COHORT

    PubMed Central

    SHAMEER, KHADER; JOHNSON, KIPP W; YAHI, ALEXANDRE; MIOTTO, RICCARDO; LI, LI; RICKS, DORAN; JEBAKARAN, JEBAKUMAR; KOVATCH, PATRICIA; SENGUPTA, PARTHO P.; GELIJNS, ANNETINE; MOSKOVITZ, ALAN; DARROW, BRUCE; REICH, DAVID L; KASARSKIS, ANDREW; TATONETTI, NICHOLAS P.; PINNEY, SEAN; DUDLEY, JOEL T

    2016-01-01

    Reduction of preventable hospital readmissions that result from chronic or acute conditions like stroke, heart failure, myocardial infarction and pneumonia remains a significant challenge for improving the outcomes and decreasing the cost of healthcare delivery in the United States. Patient readmission rates are relatively high for conditions like heart failure (HF) despite the implementation of high-quality healthcare delivery operation guidelines created by regulatory authorities. Multiple predictive models are currently available to evaluate potential 30-day readmission rates of patients. Most of these models are hypothesis driven and repetitively assess the predictive abilities of the same set of biomarkers as predictive features. In this manuscript, we discuss our attempt to develop a data-driven, electronic-medical record-wide (EMR-wide) feature selection approach and subsequent machine learning to predict readmission probabilities. We have assessed a large repertoire of variables from electronic medical records of heart failure patients in a single center. The cohort included 1,068 patients with 178 patients were readmitted within a 30-day interval (16.66% readmission rate). A total of 4,205 variables were extracted from EMR including diagnosis codes (n=1,763), medications (n=1,028), laboratory measurements (n=846), surgical procedures (n=564) and vital signs (n=4). We designed a multistep modeling strategy using the Naïve Bayes algorithm. In the first step, we created individual models to classify the cases (readmitted) and controls (non-readmitted). In the second step, features contributing to predictive risk from independent models were combined into a composite model using a correlation-based feature selection (CFS) method. All models were trained and tested using a 5-fold cross-validation method, with 70% of the cohort used for training and the remaining 30% for testing. Compared to existing predictive models for HF readmission rates (AUCs in the range

  15. PREDICTIVE MODELING OF HOSPITAL READMISSION RATES USING ELECTRONIC MEDICAL RECORD-WIDE MACHINE LEARNING: A CASE-STUDY USING MOUNT SINAI HEART FAILURE COHORT.

    PubMed

    Shameer, Khader; Johnson, Kipp W; Yahi, Alexandre; Miotto, Riccardo; Li, L I; Ricks, Doran; Jebakaran, Jebakumar; Kovatch, Patricia; Sengupta, Partho P; Gelijns, Sengupta; Moskovitz, Alan; Darrow, Bruce; David, David L; Kasarskis, Andrew; Tatonetti, Nicholas P; Pinney, Sean; Dudley, Joel T

    2016-01-01

    Reduction of preventable hospital readmissions that result from chronic or acute conditions like stroke, heart failure, myocardial infarction and pneumonia remains a significant challenge for improving the outcomes and decreasing the cost of healthcare delivery in the United States. Patient readmission rates are relatively high for conditions like heart failure (HF) despite the implementation of high-quality healthcare delivery operation guidelines created by regulatory authorities. Multiple predictive models are currently available to evaluate potential 30-day readmission rates of patients. Most of these models are hypothesis driven and repetitively assess the predictive abilities of the same set of biomarkers as predictive features. In this manuscript, we discuss our attempt to develop a data-driven, electronic-medical record-wide (EMR-wide) feature selection approach and subsequent machine learning to predict readmission probabilities. We have assessed a large repertoire of variables from electronic medical records of heart failure patients in a single center. The cohort included 1,068 patients with 178 patients were readmitted within a 30-day interval (16.66% readmission rate). A total of 4,205 variables were extracted from EMR including diagnosis codes (n=1,763), medications (n=1,028), laboratory measurements (n=846), surgical procedures (n=564) and vital signs (n=4). We designed a multistep modeling strategy using the Naïve Bayes algorithm. In the first step, we created individual models to classify the cases (readmitted) and controls (non-readmitted). In the second step, features contributing to predictive risk from independent models were combined into a composite model using a correlation-based feature selection (CFS) method. All models were trained and tested using a 5-fold cross-validation method, with 70% of the cohort used for training and the remaining 30% for testing. Compared to existing predictive models for HF readmission rates (AUCs in the range

  16. Metadata - National Hospital Ambulatory Medical Care Survey (NHAMCS)

    EPA Pesticide Factsheets

    The National Hospital Ambulatory Medical Care Survey (NHAMCS) is designed to collect information on the services provided in hospital emergency and outpatient departments and in ambulatory surgery centers.

  17. Changes to Hospital Inpatient Volume After Newspaper Reporting of Medical Errors.

    PubMed

    Fukuda, Haruhisa

    2017-06-30

    The aim of this study was to investigate the influence of medical error case reporting by national newspapers on inpatient volume at acute care hospitals. A case-control study was conducted using the article databases of 3 major Japanese newspapers with nationwide circulation between fiscal years 2012 and 2013. Data on inpatient volume at acute care hospitals were obtained from a Japanese government survey between fiscal years 2011 and 2014. Panel data were constructed and analyzed using a difference-in-differences design. Acute care hospitals in Japan. Hospitals named in articles that included the terms "medical error" and "hospital" were designated case hospitals, which were matched with control hospitals using corresponding locations, nurse-to-patient ratios, and bed numbers. Medical error case reporting in newspapers. Changes to hospital inpatient volume after error reports. The sample comprised 40 case hospitals and 40 control hospitals. Difference-in-differences analyses indicated that newspaper reporting of medical errors was not significantly associated (P = 0.122) with overall inpatient volume. Medical error case reporting by newspapers showed no influence on inpatient volume. Hospitals therefore have little incentive to respond adequately and proactively to medical errors. There may be a need for government intervention to improve the posterror response and encourage better health care safety.

  18. Evaluation of hospital medication inventory policies.

    PubMed

    Gebicki, Marek; Mooney, Ed; Chen, Shi-Jie Gary; Mazur, Lukasz M

    2014-09-01

    As supply chain costs constitute a large portion of hospitals' operating expenses and with $27.7 billion spent by the US hospitals on drugs alone in 2009, improving medication inventory management provides a great opportunity to decrease the cost of healthcare. This study investigates different management approaches for a system consisting of one central storage location, the main pharmacy, and multiple dispensing machines located in each department. Each medication has a specific unit cost, availability from suppliers, criticality level, and expiration date. Event-driven simulation is used to evaluate the performance of several inventory policies based on the total cost and patient safety (service level) under various arrangements of the system defined by the number of drugs and departments, and drugs' criticality, availability, and expiration levels. Our results show that policies that incorporate drug characteristics in ordering decisions can address the tradeoff between patient safety and cost. Indeed, this study shows that such policies can result in higher patient safety and lower overall cost when compared to traditional approaches. Additional insights from this study allow for better understanding of the medication inventory system's dynamics and suggest several directions for future research in this topic. Findings of this study can be applied to help hospital pharmacies with managing their inventory.

  19. [The characteristics of medical technologies in emergency medical care hospital].

    PubMed

    Murakhovskiĭ, A G; Babenko, A I; Bravve, Iu I; Tataurova, E A

    2013-01-01

    The article analyzes the implementation of major 12 diagnostic and 17 treatment technologies applied during medical care of patients with 12 key nosology forms of diseases in departments of the emergency medical care hospital No 2 of Omsk. It is established that key groups of technologies in the implementation of diagnostic process are the laboratory clinical diagnostic analyses and common diagnostic activities at reception into hospital and corresponding departments. The percentage of this kind of activities is about 78.3% of all diagnostic technologies. During the realization of treatment process the priority technologies are common curative and rehabilitation activities, intensive therapy activities and clinical diagnostic monitoring activities. All of them consist 80.1% of all curative technologies.

  20. [Minor emergency cases in big hospitals].

    PubMed

    Streuli, Rolf A

    2015-01-01

    Our hospitals are suffering from an increasing run of "minor emergency cases". Those are simple medical or surgical ailments that could be taken care of by a general practitioner's office in a competent and cost efficient way. Because of the ever growing problem of a shortage of general practitioners, those patients are directly going to the emergency room of our hospitals, where they are usually seen by a young and yet unexperienced doctor, who is ordering an expensive battery of tests even for minor troubles of his or her wellbeing. It was shown that emergency room crowding has a negative impact on the quality of patient care. The establishment of an office run by a general practitioner within the hospital emergency room may result in a certain relief of the situation.

  1. The Research of Medical Safety Information Engineering in Hospital Application Study

    NASA Astrophysics Data System (ADS)

    Jian, Hao; Fan, Zhang; Li-nong, Yu; Jie, Wang; Jun, Fei; Ping, Hao; Ya-wei, Shen; Yue-jin, Chang

    Objective-Explore and research the application effect of medical security information engineering in the hospital. Methods-Based on the real examples of the medical security hidden danger, the transportation module system of medical security is set up. By the all survival cycle's theory and IOP modeling method, four modules of structure model are developed, which are disposal of medical hidden danger. Results-The medical information system is developed, which includes four-in-one modules of structure model of integrated medical security transportation system, disputes evaluation system, protocol handling system, medical case analysis and handling system. And it is applied in the implementation of hospital management. Conclusions-The application of the research in the implementation of hospital management can find security hidden danger of hospital timely, the objective existence of medical disputes problems timely. And it can solve medical disputes timely and appropriately, and achieve ideal result, which is worth popularizing and applying in the hospital management.

  2. Hospital case management and the Utilization Review Committee.

    PubMed

    Orland, Richard A

    2011-01-01

    This article describes the overall regulatory mandate governing the Utilization Review Committee (URC) in the hospital setting. General structure, function, and meeting format of the URC are important considerations. Furthermore, the URC can serve as a vital platform for medical staff leadership and case management practice to use pertinent risk-adjusted data to drive needed change at the organizational, departmental, service line, and physician level. A case history illustrates the importance of these issues. Acute care hospitals. Case management staff, medical advisors, and physician leaders play important roles in driving changes. The URC will become ever-more important in the rapidly accelerating changes, driving heightened accountability on the part of hospitals.

  3. [Discharge from hospital: how to improve continuity of medical care?].

    PubMed

    Garnier, A; Uhlmann, M; Griesser, A-C; Lamy, O

    2015-11-04

    Early readmission is the major success indicator of the transition between hospital and home. Patients admitted with heart failure reach a 20% rate. Potentially avoidable readmissions, defined as unpredictable and related to a known condition during index hospitalization, represent the improvement margin. For these latter, implementation of specific interventions can be effective. Complex interventions on transition, including several modalities and seeking to encourage patient autonomy seem more effective than others. We describe two models: a pragmatic one developed in a regional hospital, and a more complex one developed in a university hospital during the LEAR-HF study. In both cases, it is imperative to work on "medical liability": should it extend beyond discharge up to the threshold of the private practice?

  4. Jackson Park Hospital Green Building Medical Center

    SciTech Connect

    William Dorsey; Nelson Vasquez

    2010-03-31

    Jackson Park Hospital completed the construction of a new Medical Office Building on its campus this spring. The new building construction has adopted the City of Chicago's recent focus on protecting the environment, and conserving energy and resources, with the introduction of green building codes. Located in a poor, inner city neighborhood on the South side of Chicago, Jackson Park Hospital has chosen green building strategies to help make the area a better place to live and work. The new green building houses the hospital's Family Medicine Residency Program and Specialty Medical Offices. The residency program has been vital in attracting new, young physicians to this medically underserved area. The new outpatient center will also help to allure needed medical providers to the community. The facility also has areas designated to women's health and community education. The Community Education Conference Room will provide learning opportunities to area residents. Emphasis will be placed on conserving resources and protecting our environment, as well as providing information on healthcare access and preventive medicine. The new Medical Office Building was constructed with numerous energy saving features. The exterior cladding of the building is an innovative, locally-manufactured precast concrete panel system with integral insulation that achieves an R-value in excess of building code requirements. The roof is a 'green roof' covered by native plantings, lessening the impact solar heat gain on the building, and reducing air conditioning requirements. The windows are low-E, tinted, and insulated to reduce cooling requirements in summer and heating requirements in winter. The main entrance has an air lock to prevent unconditioned air from entering the building and impacting interior air temperatures. Since much of the traffic in and out of the office building comes from the adjacent Jackson Park Hospital, a pedestrian bridge connects the two buildings, further

  5. Medical hospitalizations in prostate cancer survivors.

    PubMed

    Gnanaraj, Jerome; Balakrishnan, Shobana; Umar, Zarish; Antonarakis, Emmanuel S; Pavlovich, Christian P; Wright, Scott M; Khaliq, Waseem

    2016-07-01

    The objectives of the study were to explore the context and reasons for medical hospitalizations among prostate cancer survivors and to study their relationship with obesity and the type of prostate cancer treatment. A retrospective review of medical records was performed at an academic institution for male patients aged 40 years and older who were diagnosed and/or treated for prostate cancer 2 years prior to the study's observation period from January 2008 to December 2010. Unpaired t test, ANOVA, and Chi-square tests were used to compare patients' characteristics, admission types, and medical comorbidities by body mass index (BMI) and prostate cancer treatment. Mean age for the study population was 76 years (SD = 9.2). Two hundred and forty-five prostate cancer survivors were stratified into two groups: non-obese (BMI < 30 kg/m(2)) and obese (BMI ≥ 30 kg/m(2)). The study population's characteristics analyzed by BMI were similar including Gleason score, presence of metastatic disease and genitourinary-related side effects. Only 13 % of admissions were for complaints related to their genitourinary system. Neither the specific treatment that the patients had received for their prostate cancer, nor obesity was associated with the reasons for their medical admission. Survivorship after having a diagnosis of prostate cancer is often lengthy, and these men are at risk of being hospitalized, as they get older. From this inquiry, it has become clear that neither body mass index nor prior therapy is associated with specific admission characteristics, and only a minority of such admissions was directly related to prostate cancer or the genitourinary tract.

  6. Medical museum, 2nd surgical hospital.

    PubMed

    Hawk, Alan J

    2013-12-01

    When his unit, the 2nd Surgical Hospital (MA), was established at An Khe in January 1966, MAJ Rich began collecting retrieved foreign bodies along with documentation of the wound. A museum displaying these objects was established at one end of the operating room Quonset hut. During Rich's tour of duty, there were 324 cases where the patient was wounded by a punji stick, representing 38% wounds because of hostile action.

  7. Characterization of medical waste from hospitals in Tabriz, Iran.

    PubMed

    Taghipour, Hassan; Mosaferi, Mohammad

    2009-02-15

    Medical waste has not received enough attention in recent decades in Iran, as is the case in most economically developing countries. Medical waste is still handled and disposed of together with domestic waste, creating great health risks to health-care stuff, municipal workers, the public, and the environment. A fundamental prerequisite for the successful implementation of any medical waste management plan is the availability of sufficient and accurate information about the quantities and composition of the waste generated. The objectives of this study were to determine the quantity, generation rate, quality, and composition of medial waste generated in the major city northwest of Iran in Tabriz. Among the 25 active hospitals in the city, 10 hospitals of different size, specializations, and categories (i.e., governmental, educational, university, private, non-governmental organization (NGO), and military) were selected to participate in the survey. Each hospital was analyzed for a week to capture the daily variations of quantity and quality. The results indicated that the average (weighted mean) of total medical waste, hazardous-infectious waste, and general waste generation rates in Tabriz city is 3.48, 1.039 and, 2.439 kg/bed-day, respectively. In the hospital waste studied, 70.11% consisted of general waste, 29.44% of hazardous-infectious waste, and 0.45% of sharps waste (total hazardous-infectious waste 29.89%). Of the maximum average daily medical waste, hazardous-infectious waste, and general waste were associated with N.G.O and private hospitals, respectively. The average composition of hazardous-infectious waste was determined to be 35.72% plastics, 20.84% textiles, 16.70% liquids, 11.36% paper/cardboard, 7.17% glass, 1.35% sharps, and 6.86% others. The average composition of general waste was determined to be 46.87% food waste, 16.40% plastics, 13.33% paper/cardboard, 7.65% liquids, 6.05% textiles, 2.60% glass, 0.92% metals, and 6.18% others. The average

  8. Use of sleep medications in hospitalized pediatric patients.

    PubMed

    Meltzer, Lisa J; Mindell, Jodi A; Owens, Judith A; Byars, Kelly C

    2007-06-01

    Little is known about the medications prescribed for sleep in hospitalized children. The aims of this study were to (1) determine the percentage of hospitalized children who receive medication for sleep disturbances, (2) determine what medications are prescribed for sleep difficulties, and (3) examine medical and demographic variables related to medications prescribed during hospitalization. A chart review was conducted for all inpatients at 3 pediatric hospitals across 26 randomly selected days in 2004. Demographic, medical, and medication data were collected on 9440 patients. The sample was 54.5% male, had a mean age of 7.0 years, and was 63% white. Almost 19% of the patients had at least 1 psychiatric diagnosis. Overall, 6.0% of all hospitalized children (3% of all medically hospitalized children, excluding children with a psychiatric diagnosis) were prescribed medications for sleep, with antihistamines the most frequently prescribed medication (36.6%), followed by benzodiazepines (19.4%); hypnotic agents were the least frequently prescribed (2.2%). Significant differences were found in both the frequency of sleep-medication prescriptions and the types of medications used across hospitals, as well as for age, length of hospitalization, and service that the child was discharged from. Children with a psychiatric diagnosis were more likely to receive a sleep medication, with 22% of children on a psychiatric service receiving a sleep-related medication. Approximately 3% to 6% of children are treated pharmacologically with a broad array of sleep medications in hospital settings. Prescription practices vary by hospital, medical service, child age, and diagnosis. The results from this study indicate that medications are being prescribed for sleep in hospitalized children, especially in children with psychiatric diagnoses. However, given that there are neither Food and Drug Administration-approved sleep medications for children nor clinical consensus guidelines

  9. Medical Student Education in State Psychiatric Hospitals: A Survey of US State Hospitals.

    PubMed

    Nurenberg, Jeffry R; Schleifer, Steven J; Kennedy, Cheryl; Walker, Mary O; Mayerhoff, David

    2016-04-01

    State hospitals may be underutilized in medical education. US state psychiatric hospitals were surveyed on current and potential psychiatry medical student education. A 10-item questionnaire, with multiple response formats, was sent to identified hospitals in late 2012. Ninety-seven of 221 hospitals contacted responded. Fifty-three (55%) reported current medical student education programs, including 27 clinical clerkship rotations. Education and training in other disciplines was prevalent in hospitals both with and without medical students. The large majority of responders expressed enthusiasm about medical education. The most frequent reported barrier to new programs was geographic distance from the school. Limited resources were limiting factors for hospitals with and without current programs. Only a minority of US state hospitals may be involved in medical student education. While barriers such as geographic distance may be difficult to overcome, responses suggest opportunities for expanding medical education in the state psychiatric hospitals.

  10. Shallow medication extraction from hospital patient records.

    PubMed

    Boytcheva, Svetla

    2011-01-01

    This paper presents methods for shallow Information Extraction (IE) from the free text zones of hospital Patient Records (PRs) in Bulgarian language in the Patient Safety through Intelligent Procedures in medication (PSIP) project. We extract automatically information about drug names, dosage, modes and frequency and assign the corresponding ATC code to each medication event. Using various modules for rule-based text analysis, our IE components in PSIP perform a significant amount of symbolic computations. We try to address negative statements, elliptical constructions, typical conjunctive phrases, and simple inferences concerning temporal constraints and finally aim at the assignment of the drug ACT code to the extracted medication events, which additionally complicates the extraction algorithm. The prototype of the system was used for experiments with a training corpus containing 1,300 PRs and the evaluation results are obtained using a test corpus containing 6,200 PRs. The extraction accuracy (f-score) for drug names is 98.42% and for dose 93.85%.

  11. Health Care Practices for Medical Textiles in Government Hospitals

    ERIC Educational Resources Information Center

    Akubue, B. N.; Anikweze, G. U.

    2015-01-01

    The purpose of this study was to investigate the health care practices for medical textiles in government hospitals Enugu State, Nigeria. Specifically, the study determined the availability and maintenance of medical textiles in government hospitals in Enugu State, Nigeria. A sample of 1200 hospital personnel were studied. One thousand two hundred…

  12. Will decision support in medications order entry save money? A return on investment analysis of the case of the Hong Kong hospital authority.

    PubMed

    Fung, Kin Wah; Vogel, Lynn Harold

    2003-01-01

    The computerized medications order entry system currently used in the public hospitals of Hong Kong does not have decision support features. Plans are underway to add decision support to this system to alert physicians on drug-allergy conflicts, drug-lab result conflicts, drug-drug interactions and atypical dosages. A return on investment analysis is done on this enhancement, both as an examination of whether there is a positive return on the investment and as a contribution to the ongoing discussion of the use of return on investment models in health care information technology investments. It is estimated that the addition of decision support will reduce adverse drug events by 4.2 - 8.4%. Based on this estimate, a total net saving of $44,000 - $586,000 is expected over five years. The breakeven period is estimated to be between two to four years.

  13. [The Medical Collections of Milan major hospital].

    PubMed

    Galimberti, Paolo M

    2009-01-01

    This essay shows the uncommon occurrence of collections developed in a Hospital. In the past centuries the obstetrical gynaecological (since 18th Century) and anatomical collections (since 1829) were oriented to medical education, while the Pharmacy had a rich equipment. In the first half of 20th century, a Museum open to the public was planned, but the second World War and the absence of interest induce the loss of a large part of the materials. Since 2002 we had censed, collected, and listed the historical instruments, and in 2005 we realized a permanent exhibition. The collections combine about 1500 items. We have especial care to save also modern objects and equipments, after they are disused. At last we hope to realize a real Museum, and we search to assume peculiarities, goals, strength, potentials users, custom.

  14. Recognition of medical errors' reporting system dimensions in educational hospitals.

    PubMed

    Yarmohammadian, Mohammad H; Mohammadinia, Leila; Tavakoli, Nahid; Ghalriz, Parvin; Haghshenas, Abbas

    2014-01-01

    Nowadays medical errors are one of the serious issues in the health-care system and carry to account of the patient's safety threat. The most important step for achieving safety promotion is identifying errors and their causes in order to recognize, correct and omit them. Concerning about repeating medical errors and harms, which were received via theses errors concluded to designing and establishing medical error reporting systems for hospitals and centers that are presenting therapeutic services. The aim of this study is the recognition of medical errors' reporting system dimensions in educational hospitals. This research is a descriptive-analytical and qualities' study, which has been carried out in Shahid Beheshti educational therapeutic center in Isfahan during 2012. In this study, relevant information was collected through 15 face to face interviews. That each of interviews take place in about 1hr and creation of five focused discussion groups through 45 min for each section, they were composed of Metron, educational supervisor, health officer, health education, and all of the head nurses. Concluded data interviews and discussion sessions were coded, then achieved results were extracted in the presence of clear-sighted persons and after their feedback perception, they were categorized. In order to make sure of information correctness, tables were presented to the research's interviewers and final the corrections were confirmed based on their view. The extracted information from interviews and discussion groups have been divided into nine main categories after content analyzing and subject coding and their subsets have been completely expressed. Achieved dimensions are composed of nine domains of medical error concept, error cases according to nurses' prospection, medical error reporting barriers, employees' motivational factors for error reporting, purposes of medical error reporting system, error reporting's challenges and opportunities, a desired system

  15. Impact of teaching intensity and academic status on medical resource utilization by teaching hospitals in Japan.

    PubMed

    Sato, Daisuke; Fushimi, Kiyohide

    2012-11-01

    Teaching hospitals require excess medical resources to maintain high-quality care and medical education. To evaluate the appropriateness of such surplus costs, we examined the impact of teaching intensity defined as activities for postgraduate training, and academic status as functions of medical research and undergraduate teaching on medical resource utilization. Administrative data for 47,397 discharges from 40 academic and 12 non-academic teaching hospitals in Japan were collected. Hospitals were classified into three groups according to intern/resident-to-bed (IRB) ratio. Resource utilization of medical services was estimated using fee-for-service charge schedules and normalized with case mix grouping. 15-24% more resource utilization for laboratory examinations, radiological imaging, and medications were observed in hospitals with higher IRB ratios. With multivariate adjustment for case mix and academic status, higher IRB ratios were associated with 10-15% more use of radiological imaging, injections, and medications; up to 5% shorter hospital stays; and not with total resource utilization. Conversely, academic status was associated with 21-33% more laboratory examinations, radiological imaging, and medications; 13% longer hospital stays; and 10% more total resource utilization. While differences in medical resource utilization by teaching intensity may not be associated with indirect educational costs, those by academic status may be. Therefore, academic hospitals may need efficiency improvement and financial compensation.

  16. Knowledge of healthcare professionals about medication errors in hospitals.

    PubMed

    Abdel-Latif, Mohamed M M

    2016-06-01

    Medication errors are the most common types of medical errors in hospitals and leading cause of morbidity and mortality among patients. The aim of the present study was to assess the knowledge of healthcare professionals about medication errors in hospitals. A self-administered questionnaire was distributed to randomly selected healthcare professionals in eight hospitals in Madinah, Saudi Arabia. An 18-item survey was designed and comprised questions on demographic data, knowledge of medication errors, availability of reporting systems in hospitals, attitudes toward error reporting, causes of medication errors. Data were analyzed with Statistical Package for the Social Sciences software Version 17. A total of 323 of healthcare professionals completed the questionnaire with 64.6% response rate of 138 (42.72%) physicians, 34 (10.53%) pharmacists, and 151 (46.75%) nurses. A majority of the participants had a good knowledge about medication errors concept and their dangers on patients. Only 68.7% of them were aware of reporting systems in hospitals. Healthcare professionals revealed that there was no clear mechanism available for reporting of errors in most hospitals. Prescribing (46.5%) and administration (29%) errors were the main causes of errors. The most frequently encountered medication errors were anti-hypertensives, antidiabetics, antibiotics, digoxin, and insulin. This study revealed differences in the awareness among healthcare professionals toward medication errors in hospitals. The poor knowledge about medication errors emphasized the urgent necessity to adopt appropriate measures to raise awareness about medication errors in Saudi hospitals.

  17. Discharge against medical advice at a general hospital in Catalonia.

    PubMed

    Duñó, Rosó; Pousa, Esther; Sans, Jordi; Tolosa, Carles; Ruiz, Ada

    2003-01-01

    Some studies on discharge against medical advice (AMA) in general hospitals report a prevalence between 0.7-7% with 11-42% of this population identified as psychiatric patients. To study the sociodemographic and psychopathological features of patients who leave AMA, we performed a retrospective case-control comparison study of length of hospitalization and presence of psychiatric disturbances on patients who left AMA from the University General Hospital in Catalan Spain over a two-year period. An analysis of the hospital epidemiological discharge register and retrospective chart review for presence of psychiatric disturbances found that AMA prevalence was 0.34%, the total discharge number in the 2-year period being 41,648. AMA rates by medical department were 0.44% for the internal medicine department; 0.24% for surgery; 0.26% for orthopedic surgery, 0.32% for obstetrics-gynecology and 0.93% for rehabilitation. The mean age for AMA patients was 38.63 years, with a higher number of men (59.9%). A total of 45.8% AMA discharges were from the internal medicine department. No significant differences were found in the average length of hospitalization between the AMA and control groups. The presence of psychiatric pathology was significantly higher among the AMA group (P<.05). The prevalence of AMA at our hospital was low in comparison to the rates reported in the literature. The patient at high risk for AMA discharge is a young man with a history of psychiatric pathology, mainly narcotic dependence.

  18. Analysis of the Children's Hospital Graduate Medical Education Program Fund Allocations for Indirect Medical Education Costs.

    ERIC Educational Resources Information Center

    Wynn, Barbara O.; Kawata, Jennifer

    This study analyzed issues related to estimating indirect medical education costs specific to pediatric discharges. The Children's Hospital Graduate Medical Education (CHGNE) program was established to support graduate medical education in children's hospitals. This provision authorizes payments for both direct and indirect medical education…

  19. [Application of HIS Hospital Management System in Medical Equipment].

    PubMed

    Li, Yucheng

    2015-07-01

    To analyze the effect of HIS hospital management system in medical equipment. From April 2012 to 2013 in our hospital 5 100 sets of medical equipment as the control group, another 2013 in our hospital from April 2014 may 100 sets of medical equipment as the study group, comparative analysis of two groups of medical equipment scrap rate, usage, maintenance score and the score of benefit etc. Control group and taken to hospital information system, his research group equipment scrap rate, there was a significant difference, the research group of equipment maintenance score and efficiency scores were higher than those of the control group (P < 0.05), the study group of equipment maintenance score and efficiency scores were higher than those of the control group. HIS hospital management system for medical equipment management has positive clinical application value, can effectively improve the use of medical equipment, it is worth to draw and promote.

  20. A survey of hospitals managing human rabies cases in India.

    PubMed

    Sudarshan, M K; Ashwath Narayana, D H

    2010-01-01

    A survey of 23 infectious diseases (ID) hospitals/ID wards of general hospitals was done during 2008-09 to assess the facilities for and management of rabies patients. All were Government hospitals and 0.5% of total beds was earmarked for rabies cases. The hospitals were mostly run by medical colleges (47.8%) and ID hospitals (30.4%) and located outside city limits (52.2%). The patients were admitted to 'rooms (39.1%)' and 'wards (43.5%)'. The general conditions of rabies sections i.e. sanitation and linen (65%), space and toilet (52% and 56%) and bed (47.8%) require improvements. There is a need to improve staff availability, use of personal protective wears, preventive vaccination of care providers and medicinal supplies. It is recommended to encourage hospitalization of human rabies cases to ensure a 'painless and dignified death' and this must be considered as a 'human rights' issue.

  1. Costs of children with medical complexity in Australian public hospitals.

    PubMed

    Srivastava, Rajendu; Downie, James; Hall, Jane; Reynolds, Graham

    2016-05-01

    To describe the hospital costs, hospital types and differences across states and territories for children with medical complexity cared for in Australian public hospitals. Retrospective national administrative database study of 212 Australian public hospitals from six states (excluding Queensland) and two territories that submitted cost data to the National Hospital Costing Data Collection for 2010-2011. Participants included all hospitalised patients with comparisons between adults and children (17 years of age and younger), and adults with chronic diseases and children with medical complexity. Total hospital costs were the main outcome measure. The National Hospital Costing Data Collection contained data from 212 public hospitals; total admissions (adults and children) were 3 519 140 at a total hospital cost of $16 187 400 000. Children accounted for 350 499 (9.9%) of the admissions at a total hospital cost of $1 931 585 123 (11.9%). Of all children, those with medical complexity accounted for 48 758 (13.9%), and their total hospital costs were $620 948 769 (32.1%). Six children's hospitals had 145 213 (41%) of the total children admissions at a total hospital cost of $936 041 843 (48%). Across the states and territories, the number of childhood admissions ranged from 9164 to 146 618 with 4.7-14.8% for children with medical complexity. Total hospital costs ranged from $44 to $592 million with 15.4-39.4% for children with medical complexity. The national burden of hospitalised children is substantial. Children with medical complexity only account for a small percentage of hospitalisations but almost one third of total hospital costs for children, with children's hospitals bearing the major costs. © 2016 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

  2. Assurance Cases for Medical Devices

    DTIC Science & Technology

    2011-04-28

    SEI’s  Research,  Technology,  and  System   Solu2ons  program.  With  his  colleague  John   Goodenough ,  Weinstock...contact The SEI and Medical Devices *Charles B. Weinstock and John B. Goodenough , Towards an Assurance Case Practice for Medical Devices, CMU/SEI-2009-TN

  3. 33 CFR 5.59 - Medical treatment and hospitalization.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 33 Navigation and Navigable Waters 1 2012-07-01 2012-07-01 false Medical treatment and hospitalization. 5.59 Section 5.59 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY GENERAL COAST GUARD AUXILIARY § 5.59 Medical treatment and hospitalization. When any member of the...

  4. 33 CFR 5.59 - Medical treatment and hospitalization.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 33 Navigation and Navigable Waters 1 2013-07-01 2013-07-01 false Medical treatment and hospitalization. 5.59 Section 5.59 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY GENERAL COAST GUARD AUXILIARY § 5.59 Medical treatment and hospitalization. When any member of the...

  5. 33 CFR 5.59 - Medical treatment and hospitalization.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 33 Navigation and Navigable Waters 1 2014-07-01 2014-07-01 false Medical treatment and... GENERAL COAST GUARD AUXILIARY § 5.59 Medical treatment and hospitalization. When any member of the... other specific duty to which they have been assigned shall be entitled to the same hospital treatment as...

  6. 33 CFR 5.59 - Medical treatment and hospitalization.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false Medical treatment and hospitalization. 5.59 Section 5.59 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY GENERAL COAST GUARD AUXILIARY § 5.59 Medical treatment and hospitalization. When any member of the...

  7. 33 CFR 5.59 - Medical treatment and hospitalization.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 33 Navigation and Navigable Waters 1 2011-07-01 2011-07-01 false Medical treatment and hospitalization. 5.59 Section 5.59 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY GENERAL COAST GUARD AUXILIARY § 5.59 Medical treatment and hospitalization. When any member of the...

  8. Framework for preventing accidental falls in hospitals - management plan for ADL, medication and medical conditions.

    PubMed

    Kato, Shogo; Tsuru, Satoko; Iizuka, Yoshinori

    2009-01-01

    Prevention and reduction of medical accidents is essential. Among medical accidents, accidental falls remain a serious problem. While "assessment score sheets" have already been used in hospitals to prevent accidental falls, satisfactory results have not actually been achieved. In this study, we aim to establish a methodology for preventing accidental falls. We consider that the 'management plan' for each patient includes three factors. A plan of instructions for patients on actions they can take for safety in their ADL (Activities of Daily Living) is essential as a base. Second, a plan to keep up with any short term change in a patient's state is needed, because the state of a hospitalized patient will usually be temporarily affected by medication and changing medical conditions. We develop a model for preventing accidental falls, which enable us to design appropriate management plan for each patient. Then, we develop a prototype system based on the designed model. Finally, we address the result of verification of the model, by applying the prototype system into actual cases in hospitals.

  9. [The study of medical supplies automation replenishment algorithm in hospital on medical supplies supplying chain].

    PubMed

    Sheng, Xi

    2012-07-01

    The thesis aims to study the automation replenishment algorithm in hospital on medical supplies supplying chain. The mathematical model and algorithm of medical supplies automation replenishment are designed through referring to practical data form hospital on the basis of applying inventory theory, greedy algorithm and partition algorithm. The automation replenishment algorithm is proved to realize automatic calculation of the medical supplies distribution amount and optimize medical supplies distribution scheme. A conclusion could be arrived that the model and algorithm of inventory theory, if applied in medical supplies circulation field, could provide theoretical and technological support for realizing medical supplies automation replenishment of hospital on medical supplies supplying chain.

  10. Teaching hospital costs: the effects of medical staff characteristics.

    PubMed Central

    Custer, W S; Willke, R J

    1991-01-01

    This article examines the effect of medical staff behavior on the cost of hospital-based care and graduate medical education, and shows its implications for estimation of hospital costs. The empirical work brings a unique new data source for these characteristics to the estimation process. Our results indicate that there are important economies of scale and scope in hospital production, both for inpatient stays and for residency training. Controlling for medical staff characteristics significantly reduces the estimated costs of residency training. Staff characteristics may be capturing aspects of the quality of inpatient care and residency training provided by the hospital. PMID:1991676

  11. Logistics in hospitals: a case study of some Singapore hospitals.

    PubMed

    Pan, Zhi Xiong; Pokharel, Shaligram

    2007-01-01

    The purpose of this paper is to investigate logistics activities in Singapore hospitals. It defines various types of activities handled by a logistics division. Inventory management policy and the use of information and communication technologies (ICT) for logistics purposes are also discussed. The study identifies the nature of strategic alliances in Singapore's health care industry. This study was conducted by utilizing a framework for data collection, pre-testing the questionnaire and conducting interviews. Various relevant literature was reviewed to design the questionnaire. This study finds that logistics division carry out many related activities and some of them also provide engineering services. The hospitals make use of ICT. The hospitals are clustered under various groups to minimize the cost of operation, including the logistics related costs. However, hospitals do not see alliances with suppliers as a strategic option; rather they focus on outsourcing of logistics services. The findings also show that Singapore hospitals have a good stocking policy for both medical and non-medical items so that changes in patient mix can be easily handled. Singapore is continuously improving its health care industry and therefore, the findings will help hospitals in other regions to adopt some of the practices, like concentrating on local vendors, outsourcing, clustering, and maximum use of information technology as competitive factors that can improve the service and reduce the cost of operation. The paper suggests motivators and barriers to the use of ICT in logistics in the health care industry.

  12. Public Hospital Reform and the Principal Roles of Medical Staff.

    PubMed

    Zhang, Peiying

    2015-05-01

    During the reform of public hospitals, medical staff's enthusiasm and participation must be mobilized. In the positive factors, such as benefit, power, reputation, humanistic concern and satisfaction evaluation, benefit stands at the core position, power and reputation guides the medical staff's enthusiasm, and humanistic concern and satisfaction evaluation guarantees the enthusiasm of medical staff. By the institutionalized settings of benefit, power, reputation, and other factors, medical staffs of Xuzhou Central Hospital have been effectively mobilized, the development of hospital operates well, and the function of ensuring people health level regionally is further developed.

  13. Hemophilus influenzae meningitis at the Children's Hospital Medical Center in Boston, 1958 to 1973.

    PubMed

    Peter, G; Smith, D H

    1975-04-01

    Three hundred ninety-seven children were admitted to the Children's Hospital Medical Center, Boston between 1958 and 1973 with H. influenzae meningitis. The annual rate of admission and the percent of all cases of bacterial meningitis were not changed from that of the preceding decade. The age incidence was strikingly similar to that reported from this hospital for 1920 to 1932.

  14. Screening for depression in hospitalized medical patients.

    PubMed

    IsHak, Waguih William; Collison, Katherine; Danovitch, Itai; Shek, Lili; Kharazi, Payam; Kim, Tae; Jaffer, Karim Y; Naghdechi, Lancer; Lopez, Enrique; Nuckols, Teryl

    2017-02-01

    Depression among hospitalized patients is often unrecognized, undiagnosed, and therefore untreated. Little is known about the feasibility of screening for depression during hospitalization, or whether depression is associated with poorer outcomes, longer hospital stays, and higher readmission rates. We searched PubMed and PsycINFO for published, peer-reviewed articles in English (1990-2016) using search terms designed to capture studies that tested the performance of depression screening tools in inpatient settings and studies that examined associations between depression detected during hospitalization and clinical or utilization outcomes. Two investigators reviewed each full-text article and extracted data. The prevalence of depression ranged from 5% to 60%, with a median of 33%, among hospitalized patients. Several screening tools identified showed high sensitivity and specificity, even when self-administered by patients or when abbreviated versions were administered by individuals without formal training. With regard to outcomes, studies from several individual hospitals found depression to be associated with poorer functional outcomes, worse physical health, and returns to the hospital after discharge. These findings suggest that depression screening may be feasible in the inpatient setting, and that more research is warranted to determine whether screening for and treating depression during hospitalization can improve patient outcomes. Journal of Hospital Medicine 2017;12:118-125. © 2017 Society of Hospital Medicine.

  15. Use Of Medical Images In Today's Hospitals

    NASA Astrophysics Data System (ADS)

    Robinson, Ralph G.

    1982-01-01

    Increasingly sophisticated diagnostic imaging systems are being acquired by hospitals. The purpose of this paper is to identify the sources and types of clinical images in an academic, tertiary, acute-care, general hospital servicing a 600 to 700 bed population. An estimate is provided of the digital image information data that is being generated by these hospitals. The problems of digital archiving and area networks for successfully managing this large amount of image information will be difficult to achieve.

  16. Unit Cost of Medical Services at Different Hospitals in India

    PubMed Central

    Chatterjee, Susmita; Levin, Carol; Laxminarayan, Ramanan

    2013-01-01

    Institutional care is a growing component of health care costs in low- and middle-income countries, but local health planners in these countries have inadequate knowledge of the costs of different medical services. In India, greater utilisation of hospital services is driven both by rising incomes and by government insurance programmes that cover the cost of inpatient services; however, there is still a paucity of unit cost information from Indian hospitals. In this study, we estimated operating costs and cost per outpatient visit, cost per inpatient stay, cost per emergency room visit, and cost per surgery for five hospitals of different types across India: a 57-bed charitable hospital, a 200-bed private hospital, a 400-bed government district hospital, a 655-bed private teaching hospital, and a 778-bed government tertiary care hospital for the financial year 2010–11. The major cost component varied among human resources, capital costs, and material costs, by hospital type. The outpatient visit cost ranged from Rs. 94 (district hospital) to Rs. 2,213 (private hospital) (USD 1 = INR 52). The inpatient stay cost was Rs. 345 in the private teaching hospital, Rs. 394 in the district hospital, Rs. 614 in the tertiary care hospital, Rs. 1,959 in the charitable hospital, and Rs. 6,996 in the private hospital. Our study results can help hospital administrators understand their cost structures and run their facilities more efficiently, and we identify areas where improvements in efficiency might significantly lower unit costs. The study also demonstrates that detailed costing of Indian hospital operations is both feasible and essential, given the significant variation in the country’s hospital types. Because of the size and diversity of the country and variations across hospitals, a large-scale study should be undertaken to refine hospital costing for different types of hospitals so that the results can be used for policy purposes, such as revising payment rates

  17. Knowledge of healthcare professionals about medication errors in hospitals

    PubMed Central

    Abdel-Latif, Mohamed M. M.

    2016-01-01

    Context: Medication errors are the most common types of medical errors in hospitals and leading cause of morbidity and mortality among patients. Aims: The aim of the present study was to assess the knowledge of healthcare professionals about medication errors in hospitals. Settings and Design: A self-administered questionnaire was distributed to randomly selected healthcare professionals in eight hospitals in Madinah, Saudi Arabia. Subjects and Methods: An 18-item survey was designed and comprised questions on demographic data, knowledge of medication errors, availability of reporting systems in hospitals, attitudes toward error reporting, causes of medication errors. Statistical Analysis Used: Data were analyzed with Statistical Package for the Social Sciences software Version 17. Results: A total of 323 of healthcare professionals completed the questionnaire with 64.6% response rate of 138 (42.72%) physicians, 34 (10.53%) pharmacists, and 151 (46.75%) nurses. A majority of the participants had a good knowledge about medication errors concept and their dangers on patients. Only 68.7% of them were aware of reporting systems in hospitals. Healthcare professionals revealed that there was no clear mechanism available for reporting of errors in most hospitals. Prescribing (46.5%) and administration (29%) errors were the main causes of errors. The most frequently encountered medication errors were anti-hypertensives, antidiabetics, antibiotics, digoxin, and insulin. Conclusions: This study revealed differences in the awareness among healthcare professionals toward medication errors in hospitals. The poor knowledge about medication errors emphasized the urgent necessity to adopt appropriate measures to raise awareness about medication errors in Saudi hospitals. PMID:27330261

  18. Are language barriers associated with serious medical events in hospitalized pediatric patients?

    PubMed

    Cohen, Adam L; Rivara, Frederick; Marcuse, Edgar K; McPhillips, Heather; Davis, Robert

    2005-09-01

    Language barriers may lead to medical errors by impeding patient-provider communication. The objective of this study was to determine whether hospitalized pediatric patients whose families have language barriers are more likely to incur serious medical errors than patients whose families do not have language barriers. A case-control study was conducted in a large, academic, regional children's hospital in the Pacific Northwest. Case patients (n = 97) included all hospitalizations of patients who were younger than 21 years and had a reported serious medical event from January 1, 1998, to December 31, 2003. Control patients (n = 475) were chosen from hospitalizations without a reported serious medical event and were matched with case patients on age, admitting service, admission to intensive care, and date of admission. The main exposure was a language barrier defined by self- or provider-reported need for an interpreter. Serious medical events were defined as events that led to unintended or potentially adverse outcomes identified by the hospital's quality improvement staff. Fourteen (14.4%) of the case patients and 53 (11.2%) of the control patients were assigned an interpreter during their hospitalization. Overall, we found no increased risk for serious medical events in patients and families who requested an interpreter compared with patients and families who did not request an interpreter (odds ratio: 1.36; 95% confidence interval: 0.73-2.55). Spanish-speaking patients who requested an interpreter comprised 11 (11.3%) of the case patients and 26 (5.5%) of the control patients. This subgroup had a twofold increased risk for serious medical events compared with patients who did not request an interpreter (odds ratio: 2.26; 95% confidence interval: 1.06-4.81). Spanish-speaking patients whose families have a language barrier seem to have a significantly increased risk for serious medical events during pediatric hospitalization compared with patients whose families

  19. Hospital and medical staff strategic planning: developing an integrated approach.

    PubMed

    Zuckerman, A M

    1994-08-01

    The physician as the principal customer of the hospital is a relatively new concept, indicative of the shift to a more complete market orientation in strategic planning. Although medical staff and medical community dynamics receive increasing attention in strategic planning, much more sophistication is now needed to involve physicians constructively in strategic planning for the hospital and medical staff. While full consonance of physician and hospital plans may be achievable only in a completely integrated delivery system, there is considerable room for improvement in current organizational models.

  20. The contribution of hospital library services to continuing medical education.

    PubMed

    Gluck, Jeannine Cyr

    2004-01-01

    Much of the literature relating to continuing medical education programs laments the lack of effectiveness of traditional lecture-based format, the most often used method of presentation in hospitals. A gap exists between the content taught in lectures and the application of that knowledge in actual patient care. The services of the medical librarian, already employed in most hospitals, can help ameliorate this problem. Further, libraries help to support quality improvement efforts. These three functions (library services, continuing medical education, and quality improvement) are interdependent. Each lends strength to the other, and, ideally, all are coordinated within the hospital structure.

  1. Effective strategies to increase reporting of medication errors in hospitals.

    PubMed

    Force, Mary VanOyen; Deering, Linda; Hubbe, John; Andersen, Marcy; Hagemann, Barbara; Cooper-Hahn, Michelle; Peters, William

    2006-01-01

    A major concern for patient safety in hospitals is accurate medication administration. To improve the medication administration process, nurses and pharmacists must report system problems. Although staff supported the concept of medication error reporting, they did not report errors. Inherent fear of retribution, punitive actions, and professional humiliation prevented self-reporting of medication errors. Our hospital's quality improvement department developed, implemented, and evaluated a program called LifeSavers. Its purpose was to build a nonpunitive culture and to increase medication error reporting by staff. In one year, the LifeSavers program increased medication error disclosures from 14 to 72 reports per month. The successful development of a nonblame culture of medication error reporting led to identified sources of problems and improvement of the medication administration system.

  2. Insulin Pump Malfunction During Hospitalization: Two Case Reports.

    PubMed

    Faulds, Eileen R; Wyne, Kathleen L; Buschur, Elizabeth O; McDaniel, Jodi; Dungan, Kathleen

    2016-06-01

    Insulin pump malfunctions and failures continue to occur; however, more severe malfunctions such as the "runaway pump" phenomenon are rarely reported. This article describes two cases of pump malfunction in which pump users appear to have received an unsolicited bolus of insulin resulting in severe episodes of hypoglycemia during hospitalization. Both cases of insulin pump malfunction occurred in the inpatient setting at a large academic medical center in the United States. An analysis of the corresponding insulin pump downloads was performed. The Food and Drug Administration's (FDA's) Manufacturer and User Facility Device Experience (MAUDE) database was searched for similar cases involving Medtronic (Northridge, CA) insulin pumps using the terms "pump," "infusion," "insulin AND malfunction AND Medtronic." The two cases described show remarkable similarities, each demonstrating a severe hypoglycemic event preceded by an infusion site change followed by an alarm. In both cases a rapid spraying of insulin was reported. The insulin pump downloads validated much of the patients' and medical staff's descriptions of events. The FDA's MAUDE database search revealed 425 cases meeting our search term criteria. All cases were reviewed. Seven cases were identified involving independent movement of the reservoir piston. The cases detailed are the first to describe an insulin pump malfunction of this nature in the hospital setting involving unsolicited insulin boluses leading to severe hypoglycemia. The cases are particularly compelling in that they were witnessed by medical personnel. Providers and patients should receive instruction education on the recognition and management of insulin pump malfunction.

  3. Hip fracture in hospitalized medical patients.

    PubMed

    Zapatero, Antonio; Barba, Raquel; Canora, Jesús; Losa, Juan E; Plaza, Susana; San Roman, Jesús; Marco, Javier

    2013-01-08

    The aim of the present study is to analyze the incidence of hip fracture as a complication of admissions to internal medicine units in Spain. We analyzed the clinical data of 2,134,363 adults who had been admitted to internal medicine wards. The main outcome was a diagnosis of hip fracture during hospitalization.Outcome measures included rates of in-hospital fractures, length of stay and cost. A total of 1127 (0.057%) admittances were coded with an in-hospital hip fracture. In hospital mortality rate was 27.9% vs 9.4%; p < 0.001, and the mean length of stay was significantly longer for patients with a hip fracture (20.7 days vs 9.8 days; p < 0.001). Cost were higher in hip-fracture patients (6927€ per hospitalization vs 3730€ in non fracture patients). Risk factors related to fracture were: increasing age by 10 years increments (OR 2.32 95% CI 2.11-2.56), female gender (OR 1.22 95% CI 1.08-1.37), admission from nursing home (OR 1.65 95% CI 1.27-2.12), dementia (1.55 OR 95% CI1.30-1.84), malnutrition (OR 2.50 95% CI 1.88-3.32), delirium (OR 1.57 95% CI 1.16-2.14), and anemia (OR 1.30 95%CI 1.12-1.49). In-hospital hip fracture notably increased mortality during hospitalization, doubling the mean length of stay and mean cost of admission. These are reasons enough to stress the importance of designing and applying multidisciplinary plans focused on reducing the incidence of hip fractures in hospitalized patients.

  4. Hip fracture in hospitalized medical patients

    PubMed Central

    2013-01-01

    Background The aim of the present study is to analyze the incidence of hip fracture as a complication of admissions to internal medicine units in Spain. Methods We analyzed the clinical data of 2,134,363 adults who had been admitted to internal medicine wards. The main outcome was a diagnosis of hip fracture during hospitalization. Outcome measures included rates of in-hospital fractures, length of stay and cost. Results A total of 1127 (0.057%) admittances were coded with an in-hospital hip fracture. In hospital mortality rate was 27.9% vs 9.4%; p < 0.001, and the mean length of stay was significantly longer for patients with a hip fracture (20.7 days vs 9.8 days; p < 0.001). Cost were higher in hip-fracture patients (6927€ per hospitalization vs 3730€ in non fracture patients). Risk factors related to fracture were: increasing age by 10 years increments (OR 2.32 95% CI 2.11-2.56), female gender (OR 1.22 95% CI 1.08-1.37), admission from nursing home (OR 1.65 95% CI 1.27-2.12), dementia (1.55 OR 95% CI1.30-1.84), malnutrition (OR 2.50 95% CI 1.88-3.32), delirium (OR 1.57 95% CI 1.16-2.14), and anemia (OR 1.30 95%CI 1.12-1.49). Conclusions In-hospital hip fracture notably increased mortality during hospitalization, doubling the mean length of stay and mean cost of admission. These are reasons enough to stress the importance of designing and applying multidisciplinary plans focused on reducing the incidence of hip fractures in hospitalized patients. PMID:23298165

  5. Medical staff appointment and delineation of pediatric privileges in hospitals.

    PubMed

    Rauch, Daniel A

    2012-04-01

    The review and verification of credentials and the granting of clinical privileges are required of every hospital to ensure that members of the medical staff are competent and qualified to provide specified levels of patient care. The credentialing process involves the following: (1) assessment of the professional and personal background of each practitioner seeking privileges; (2) assignment of privileges appropriate for the clinician's training and experience; (3) ongoing monitoring of the professional activities of each staff member; and (4) periodic reappointment to the medical staff on the basis of objectively measured performance. We examine the essential elements of a credentials review for initial and renewed medical staff appointments along with suggested criteria for the delineation of clinical privileges. Sample forms for the delineation of privileges can be found on the American Academy of Pediatrics Committee on Hospital Care Web site (http://www.aap.org/visit/cmte19.htm). Because of differences among individual hospitals, no 1 method for credentialing is universally applicable. The medical staff of each hospital must, therefore, establish its own process based on the general principles reviewed in this report. The issues of medical staff membership and credentialing have become very complex, and institutions and medical staffs are vulnerable to legal action. Consequently, it is advisable for hospitals and medical staffs to obtain expert legal advice when medical staff bylaws are constructed or revised.

  6. A "Medical Physics" Course Based Upon Hospital Field Experience

    ERIC Educational Resources Information Center

    Onn, David G.

    1972-01-01

    Describes a noncalculus, medical physics'' course with a basic element of direct hospital field experience. The course is intended primarily for premedical students but may be taken by nonscience majors. (Author/PR)

  7. International travel as medical research: architecture and the modern hospital.

    PubMed

    Logan, Cameron; Willis, Julie

    2010-01-01

    The design and development of the modern hospital in Australia had a profound impact on medical practice and research at a variety of levels. Between the late 1920s and the 1950s hospital architects, administrators, and politicians travelled widely in order to review the latest international developments in the hospital field They were motivated by Australia's geographic isolation and a growing concern with how to govern the population at the level of physical health. While not 'medical research' in the conventional sense of the term, this travel was a powerful generator of medical thinking in Australia and has left a rich archival legacy. This paper draws on that archive to demonstrate the ways in which architectural research and international networks of hospital specialists profoundly shaped the provision of medical infrastructure in Australia.

  8. Prevention of venous thromboembolism in the hospitalized medical patient.

    PubMed

    Jaffer, Amir K; Amin, Alpesh N; Brotman, Daniel J; Deitelzweig, Steven B; McKean, Sylvia C; Spyropoulos, Alex C

    2008-04-01

    Hospitalized acutely ill medical patients are at high risk for venous thromboembolism (VTE), and clinical trials clearly demonstrate that pharmacologic prophylaxis of VTE for up to 14 days significantly reduces the incidence of VTE in this population. Guidelines recommend use of low-molecular-weight heparin (LMWH) or unfractionated heparin (5,000 U three times daily) for VTE prophylaxis in hospitalized medical patients with risk factors for VTE; in patients with contraindications to anticoagulants, mechanical prophylaxis is recommended. All hospitalized medical patients should be assessed for their risk of VTE at admission and daily thereafter, and those with reduced mobility and one or more other VTE risk factors are candidates for aggressive VTE prophylaxis. Based on results from the recently reported EXCLAIM trial, extended postdischarge prophylaxis with LMWH for 28 days should be considered for hospitalized medical patients with reduced mobility who are older than age 75 or have a cancer diagnosis or a history of VTE.

  9. Hospital and medical care days in pancreatic cancer.

    PubMed

    Boyd, Casey A; Branch, Daniel W; Sheffield, Kristin M; Han, Yimei; Kuo, Yong-Fang; Goodwin, James S; Riall, Taylor S

    2012-08-01

    Little is known about resource utilization (number of days in the hospital or medical care) between diagnosis and death in patients with pancreatic cancer. Using Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data, we identified 25,476 patients with pancreatic cancer (1992-2005). Hospital and medical care days per person-month from the time of diagnosis were described, stratified by stage, treatment, and survival duration. Hospital/medical care days vary by length of survival and treatment strategy in patients with pancreatic cancer. For all stages, patients were in the hospital a mean of 6.4 days and received medical care a total of 9.0 days in the first month after diagnosis, decreasing to 1.7 and 3.7 days per month, respectively, by the end of the first year. Hospital/medical care days per month of life were higher in patients with shorter survival but increased sharply at the end of life in all patients, regardless of duration of survival. In patients with locoregional disease, resection was associated with a higher number of hospital/medical care days during the first 4 months after diagnosis, but fewer at the end of the first year. For distant disease, hospital days were similar but days in medical care were higher for patients receiving chemotherapy, increasing especially at the end of life. This study is the first to quantify hospital/medical care days in patients with pancreatic cancer by stage, treatment, and survival. This information will provide realistic expectations and allow for treatment decisions based on patient preferences.

  10. Case-based hospital financing: the case of Norway.

    PubMed

    Magnussen, J; Solstad, K

    1994-03-01

    Several European countries are experimenting with new ways of organising and financing the hospital sector. This paper discusses the present Norwegian reform, where a system of fixed grants is replaced by a combination of payment per case and fixed grants. Initially implemented in four hospitals only, the decision to move to a full-scale reform will be based on the evaluation of this pilot project. The paper presents two alternative hypotheses on how a system with case-based financing will influence the performance of hospitals. Given that hospitals adjust passively to the constraints imposed by the financing system, increased efficiency is to be expected. If hospitals and hospital owners (i.e. the counties) interact in a game dominated by the hospital, however, the efficiency of the hospital will not be influenced by the financing system. We argue that the design of the pilot project limits the possibility of discriminating between these two hypotheses. Nevertheless, a comparison of key variables in the pilot hospitals with a set of reference hospitals indicates that the change of financing system has not had any substantial effect on hospital efficiency. Thus we are inclined to believe that hospitals in fact are able to set the level of efficiency independent of whether they are financed by fixed grants or a payment per case.

  11. Medical technology management in U.S. hospitals.

    PubMed

    Baretich, Matthew F

    2002-01-01

    Medical technologies move from research and development through manufacturing and marketing into the healthcare delivery system. Within the healthcare delivery system, hospitals rely heavily on medical technologies (and the medical devices they enable) to provide diagnosis, treatment, and monitoring in patient care. Managing these devices from acquisition through application in patient care is a formidable task. Hospitals must act to maximize the benefits of medical devices while minimizing adverse side effects. They must do so within a highly regulated and cost-constrained environment. This paper describes the challenges hospitals face and the strategies they employ in their efforts to achieve cost-effective medical technology management. The role of clinical engineering is discussed.

  12. Skin diseases in companion guinea pigs (Cavia porcellus): a retrospective study of 293 cases seen at the Veterinary Medical Teaching Hospital, University of California at Davis (1990-2015).

    PubMed

    White, Stephen D; Guzman, David Sanchez-Migallon; Paul-Murphy, Joanne; Hawkins, Michelle G

    2016-10-01

    Guinea pigs (Cavia porcellus) are popular companion animals with reported skin diseases, but most reports are accessed from textbooks or review articles. To document skin diseases and their prevalence in companion guinea pigs in northern California, USA, and to investigate predilections for the most common conditions over a 25 year period. Two hundred and ninety three guinea pigs from the hospital population met inclusion criteria. A retrospective study was performed by searching computerized medical records seen at the Veterinary Medical Teaching Hospital (VMTH), School of Veterinary Medicine, University of California from 1 January 1990 to 31 July 2015 using key words relevant to dermatology. Of the 580 guinea pigs seen at the VMTH, 50% (293) had skin disease. Of the 293 cases, 154 (52%) presented for nondermatological reasons. Guinea pigs with skin disease were significantly older than those without skin disease (P = 0.0002); females with skin disease were more likely to have cystic ovaries (P = 0.0203), although these were not always associated with alopecia. Pododermatitis and infestation with Trixacarus caviae or lice were the most common skin diseases. Ivermectin or selamectin was used for ectoparasite treatment. Abscesses unassociated with pododermatitis were the most common nodules. Benign follicular tumours were the most common neoplasm. Despite the frequent mention of dermatophytosis in the veterinary literature, only two cases of Trichophyton mentagrophytes were diagnosed. Cutaneous conditions in companion guinea pigs in the USA are common. Clinicians should include a dermatological examination when examining these rodents regardless of the reason for presentation. © 2016 ESVD and ACVD.

  13. Case-based medical informatics.

    PubMed

    Pantazi, Stefan V; Arocha, José F; Moehr, Jochen R

    2004-11-08

    The "applied" nature distinguishes applied sciences from theoretical sciences. To emphasize this distinction, we begin with a general, meta-level overview of the scientific endeavor. We introduce the knowledge spectrum and four interconnected modalities of knowledge. In addition to the traditional differentiation between implicit and explicit knowledge we outline the concepts of general and individual knowledge. We connect general knowledge with the "frame problem," a fundamental issue of artificial intelligence, and individual knowledge with another important paradigm of artificial intelligence, case-based reasoning, a method of individual knowledge processing that aims at solving new problems based on the solutions to similar past problems. We outline the fundamental differences between Medical Informatics and theoretical sciences and propose that Medical Informatics research should advance individual knowledge processing (case-based reasoning) and that natural language processing research is an important step towards this goal that may have ethical implications for patient-centered health medicine. We focus on fundamental aspects of decision-making, which connect human expertise with individual knowledge processing. We continue with a knowledge spectrum perspective on biomedical knowledge and conclude that case-based reasoning is the paradigm that can advance towards personalized healthcare and that can enable the education of patients and providers. We center the discussion on formal methods of knowledge representation around the frame problem. We propose a context-dependent view on the notion of "meaning" and advocate the need for case-based reasoning research and natural language processing. In the context of memory based knowledge processing, pattern recognition, comparison and analogy-making, we conclude that while humans seem to naturally support the case-based reasoning paradigm (memory of past experiences of problem-solving and powerful case matching

  14. Case-based medical informatics

    PubMed Central

    Pantazi, Stefan V; Arocha, José F; Moehr, Jochen R

    2004-01-01

    Background The "applied" nature distinguishes applied sciences from theoretical sciences. To emphasize this distinction, we begin with a general, meta-level overview of the scientific endeavor. We introduce the knowledge spectrum and four interconnected modalities of knowledge. In addition to the traditional differentiation between implicit and explicit knowledge we outline the concepts of general and individual knowledge. We connect general knowledge with the "frame problem," a fundamental issue of artificial intelligence, and individual knowledge with another important paradigm of artificial intelligence, case-based reasoning, a method of individual knowledge processing that aims at solving new problems based on the solutions to similar past problems. We outline the fundamental differences between Medical Informatics and theoretical sciences and propose that Medical Informatics research should advance individual knowledge processing (case-based reasoning) and that natural language processing research is an important step towards this goal that may have ethical implications for patient-centered health medicine. Discussion We focus on fundamental aspects of decision-making, which connect human expertise with individual knowledge processing. We continue with a knowledge spectrum perspective on biomedical knowledge and conclude that case-based reasoning is the paradigm that can advance towards personalized healthcare and that can enable the education of patients and providers. We center the discussion on formal methods of knowledge representation around the frame problem. We propose a context-dependent view on the notion of "meaning" and advocate the need for case-based reasoning research and natural language processing. In the context of memory based knowledge processing, pattern recognition, comparison and analogy-making, we conclude that while humans seem to naturally support the case-based reasoning paradigm (memory of past experiences of problem-solving and

  15. Hospital medical waste management in Shandong Province, China.

    PubMed

    Gai, Ruoyan; Kuroiwa, Chushi; Xu, Lingzhong; Wang, Xingzhou; Zhang, Yufei; Li, Huijuan; Zhou, Chengchao; He, Jiangjian; Tang, Wei

    2009-06-01

    Medical waste refers to those hazardous waste materials generated by healthcare activities, including a broad range of materials, and remains as an issue on both public health and environment. In China, there was inadequate information on the implementation of management systems in hospitals based on the national regulatory framework. The objectives of this study were to assess the current situation of medical waste management and to identify factors determining the implementation of a management system based on the national regulatory framework in hospitals. We investigated 23 general hospitals in both urban and rural areas of Shandong Province, China, by both quantitative and qualitative approaches. The medical waste generation rate was 0.744, 0.558 and 1.534 kg bed(-1) day(-1) in tertiary hospitals, urban secondary hospitals and county hospitals, respectively. There is a wide disparity between implementation in tertiary, secondary and county hospitals. With increasing financial, technological, and materials investment, a management system has been established in tertiary and secondary hospitals. Financial support and administrative monitoring by the government is urgently needed to build a sound management system in hospitals located at remote and less-developed areas. In those areas issues in the financial, administrative and technical aspects should be further examined.

  16. Impact of a stroke unit on length of hospital stay and in-hospital case fatality.

    PubMed

    Zhu, Hai Feng; Newcommon, Nancy N; Cooper, Mary Elizabeth; Green, Teri L; Seal, Barbara; Klein, Gary; Weir, Nicolas U; Coutts, Shelagh B; Watson, Tim; Barber, Philip A; Demchuk, Andrew M; Hill, Michael D

    2009-01-01

    Randomized trials have demonstrated reduced morbidity and mortality with stroke unit care; however, the effect on length of stay, and hence the economic benefit, is less well-defined. In 2001, a multidisciplinary stroke unit was opened at our institution. We observed whether a stroke unit reduces length of stay and in-hospital case fatality when compared to admission to a general neurology/medical ward. A retrospective study of 2 cohorts in the Foothills Medical Center in Calgary was conducted using administrative databases. We compared a cohort of stroke patients managed on general neurology/medical wards before 2001, with a similar cohort of stroke patients managed on a stroke unit after 2003. The length of stay was dichotomized after being centered to 7 days and the Charlson Index was dichotomized for analysis. Multivariable logistic regression was used to compare the length of stay and case fatality in 2 cohorts, adjusted for age, gender, and patient comorbid conditions defined by the Charlson Index. Average length of stay for patients on a stroke unit (n=2461) was 15 days vs 19 days for patients managed on general neurology/medical wards (n=1567). The proportion of patients with length of stay >7 days on general neurology/medical wards was 53.8% vs 44.4% on the stroke unit (difference 9.4%; P<0.0001). The adjusted odds of a length of stay >7 days was reduced by 30% (P<0.0001) on a stroke unit compared to general neurology/medical wards. Overall in-hospital case fatality was reduced by 4.5% with stroke unit care. We observed a reduced length of stay and reduced in-hospital case-fatality in a stroke unit compared to general neurology/medical wards.

  17. [University teaching hospitals hold primacy in graduate medical education].

    PubMed

    Jaspers, Fr C A

    2006-07-01

    The university teaching hospitals are legally commissioned for the development and implementation of the initial medical training for doctors and for the training of specialist registrars, i.e. graduate medical education. They are able to carry out this task partly due to the professionals' collective sense of ambition and a strongly focussed organization that has the necessary critical mass at its disposal.

  18. Nurses' medication administration practices at two Singaporean acute care hospitals.

    PubMed

    Choo, Janet; Johnston, Linda; Manias, Elizabeth

    2013-03-01

    This study examined registered nurses' overall compliance with accepted medication administration procedures, and explored the distractions they faced during medication administration at two acute care hospitals in Singapore. A total of 140 registered nurses, 70 from each hospital, participated in the study. At both hospitals, nurses were distracted by personnel, such as physicians, radiographers, patients not under their care, and telephone calls, during medication rounds. Deviations from accepted medication procedures were observed. At one hospital, the use of a vest during medication administration alone was not effective in avoiding distractions during medication administration. Environmental factors and distractions can impact on the safe administration of medications, because they not only impair nurses' level of concentration, but also add to their work pressure. Attention should be placed on eliminating distractions through the use of appropriate strategies. Strategies that could be considered include the conduct of education sessions with health professionals and patients about the importance of not interrupting nurses while they are administering medications, and changes in work design.

  19. Maximizing Financial Resources in Veterinary Medical Teaching Hospitals.

    ERIC Educational Resources Information Center

    Walker, Terry S.

    1979-01-01

    The University of California at Davis Veterinary Medical Teaching Hospital created a healthier environment with inexpensive business procedures. Reported are: removal of billing responsibilities from faculty, separation of discharge functions from receptionist's functions, billing system/medical records system, and use of credit cards and…

  20. Patient Safety Events and Harms During Medical and Surgical Hospitalizations for Persons With Serious Mental Illness

    PubMed Central

    Daumit, Gail L.; McGinty, Emma E.; Pronovost, Peter; Dixon, Lisa B.; Guallar, Eliseo; Ford, Daniel E.; Cahoon, Elizabeth K.; Boonyasai, Romsai T.; Thompson, David

    2016-01-01

    Objective This study explored the risk of patient safety events and associated nonfatal physical harms and mortality in a cohort of persons with serious mental illness. This group experiences high rates of medical comorbidity and premature mortality and may be at high risk of adverse patient safety events. Methods Medical record review was conducted for medical-surgical hospitalizations occurring during 1994–2004 in a community-based cohort of Maryland adults with serious mental illness. Individuals were eligible if they died within 30 days of a medical-surgical hospitalization and if they also had at least one prior medical-surgical hospitalization within five years of death. All admissions took place at Maryland general hospitals. A case-crossover analysis examined the relationships among patient safety events, physical harms, and elevated likelihood of death within 30 days of hospitalization. Results A total of 790 hospitalizations among 253 adults were reviewed. The mean number of patient safety events per hospitalization was 5.8, and the rate of physical harms was 142 per 100 hospitalizations. The odds of physical harm were elevated in hospitalizations in which 22 of the 34 patient safety events occurred (p<.05), including medical events (odds ratio [OR]=1.5, 95% confidence interval [CI]=1.3–1.7) and procedure-related events (OR=1.6, CI=1.2–2.0). Adjusted odds of death within 30 days of hospitalization were elevated for individuals with any patient safety event, compared with those with no event (OR=3.7, CI=1.4–10.3). Conclusions Patient safety events were positively associated with physical harm and 30-day mortality in nonpsychiatric hospitalizations for persons with serious mental illness. PMID:27181736

  1. Patient and medication-related factors associated with hospital-acquired hyponatremia in patients hospitalized from heart failure.

    PubMed

    Saepudin, S; Ball, Patrick A; Morrissey, Hana

    2016-08-01

    Background Hyponatremia has been known as an important predictor of clinical outcomes in patients with heart failure (HF). While information on hyponatremia in patients with HF has been available abundantly, information on factors associated with increased risk of developing hospital-acquired hyponatremia (HAH) is still limited. Objective To identify patients and medication-related factors associated with HAH in patients hospitalized from HF. Setting Fatmawati Hospital in Jakarta, Indonesia. Methods This is a nested case-control study with patients developing HAH served as case group and each patient in case group was matched by age and gender to three patients in control group. Patients included in this study are patients hospitalized from HF, and coded with I.50 according to ICD-10, during 2011-2013 at Fatmawati Hospital in Jakarta, Indonesia. Information retrieved from patients' medical records included demographic profiles, vital signs and symptoms at admission, past medical history, medication during hospitalization and clinical chemistry laboratory records. Multivariable logistic regression analysis was performed to find out patient and treatment-related factors associated with the development of HAH. Main outcome measures Patients and medication related factors having significant association with HAH. Results Four hundreds sixty-four patients were included in this study and 45 of them (9.7 %) met criteria of developing HAH so then, accordingly, 135 patients were selected as controls. 36 patient- and 22 treatment-related factors were analyzed in univariate logistic regression resulted in 20 factors having p value <0.2 and were included in multivariable logistic regression analysis. Final factors showing significant association with HAH are presence of ascites at admission (odds ratio = 4.7; 95 % confidence interval 1.9-11.5) and administration of amiodarone (3.2; 1.3-7.4) and heparin (3.1; 1.2-7.3) during hospital stay. Conclusion Presence of ascites at

  2. Pediatric Nurses' Perspectives on Medication Teaching in a Children's Hospital.

    PubMed

    Gibson, Cori A; Stelter, Ashley J; Haglund, Kristin A; Lerret, Stacee M

    To explore inpatient pediatric nurses' current experiences and perspectives on medication teaching. A descriptive qualitative study was conducted at a Midwest pediatric hospital. Using convenience sampling, 26 nurses participated in six focus groups. Data were analyzed in an iterative group coding process. Three themes emerged. 1) Medication teaching is an opportunity. 2) Medication teaching is challenging. Nurses experienced structural and process challenges to deliver medication teaching. Structural challenges included the physical hospital environment, electronic health record, and institutional discharge workflow while process challenges included knowledge, relationships and interactions with caregivers, and available resources. 3) Medication teaching is amenable to improvement. Effective medication teaching with caregivers is critical to ensure safe, quality care for children after discharge. Nursing teaching practices have not changed, despite advances in technology and major changes in hospital care. Nurses face many challenges to conduct effective medication teaching. Improving current teaching practices is imperative in order to provide the best and safest care. This study generated knowledge regarding pediatric nurses' teaching practices, values and beliefs that influence teaching, barriers, and ideas for how to improve medication teaching. Results will guide the development of targeted interventions to promote successful medication teaching practices. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Medical waste production at hospitals and associated factors.

    PubMed

    Cheng, Y W; Sung, F C; Yang, Y; Lo, Y H; Chung, Y T; Li, K-C

    2009-01-01

    This study was conducted to evaluate the quantities of medical waste generated and the factors associated with the generation rate at medical establishments in Taiwan. Data on medical waste generation at 150 health care establishments were collected for analysis in 2003. General medical waste and infectious waste production at these establishments were examined statistically with the potential associated factors. These factors included the types of hospital and clinic, reimbursement payment by National Health Insurance, total number of beds, bed occupancy, number of infectious disease beds and outpatients per day. The average waste generation rates ranged from 2.41 to 3.26kg/bed/day for general medical wastes, and 0.19-0.88kg/bed/day for infectious wastes. The total average quantity of infectious wastes generated was the highest from medical centers, or 3.8 times higher than that from regional hospitals (267.8 vs. 70.3Tons/yr). The multivariate regression analysis was able to explain 92% of infectious wastes and 64% of general medical wastes, with the amount of insurance reimbursement and number of beds as significant prediction factors. This study suggests that large hospitals are the major source of medical waste in Taiwan. The fractions of medical waste treated as infectious at all levels of healthcare establishments are much greater than that recommended by the USCDC guidelines.

  4. Hospital case payment systems in Europe.

    PubMed

    Busse, Reinhard; Schreyögg, Jonas; Smith, Peter C

    2006-08-01

    Since the introduction of the system of diagnosis related groups (DRGs) for USA Medicare patients in 1983, case payment mechanisms have gradually become the principal means of reimbursing hospitals in most developed countries. The use of case payments nevertheless poses severe technical and policy challenges, and there remain many unresolved issues in their implementation. This paper introduces a special issue of the journal that describes and compares experience with the use of case payments for reimbursing hospitals in nine European countries. The editorial sets the policy scene, and argues that DRG systems must be seen both as a technical reimbursement method and as a fundamental incentive mechanism within the health system.

  5. A study of medication errors in a tertiary care hospital

    PubMed Central

    Patel, Nrupal; Desai, Mira; Shah, Samdih; Patel, Prakruti; Gandhi, Anuradha

    2016-01-01

    Objective: To determine the nature and types of medication errors (MEs), to evaluate occurrence of drug-drug interactions (DDIs), and assess rationality of prescription orders in a tertiary care teaching hospital. Materials and Methods: A prospective, observational study was conducted in General Medicine and Pediatric ward of Civil Hospital, Ahmedabad during October 2012 to January 2014. MEs were categorized as prescription error, dispensing error, and administration error (AE). The case records and treatment charts were reviewed. The investigator also accompanied the staff nurse during the ward rounds and interviewed patients or care taker to gather information, if necessary. DDIs were assessed by Medscape Drug Interaction Checker software (version 4.4). Rationality of prescriptions was assessed using Phadke's criteria. Results: A total of 1109 patients (511 in Medicine and 598 in Pediatric ward) were included during the study period. Total number of MEs was 403 (36%) of which, 195 (38%) were in Medicine and 208 (35%) were in Pediatric wards. The most common ME was PEs 262 (65%) followed by AEs 126 (31%). A potential significant DDIs were observed in 191 (17%) and serious DDIs in 48 (4%) prescriptions. Majority of prescriptions were semirational 555 (53%) followed by irrational 317 (30%), while 170 (17%) prescriptions were rational. Conclusion: There is a need to establish ME reporting system to reduce its incidence and improve patient care and safety. PMID:27843792

  6. [Improvement of medical equipment setting for the hospital link of the medical service during wartime].

    PubMed

    Miroshnichenko, Yu V; Goryachev, A B; Popov, A A; Rodionov, E O

    2016-04-01

    One of the priorities of the military health care is to improve the system of rationing medical equipment for the hospital unit of the medical service of the Armed Forces in wartime. This is determined the fact that the effectiveness of measures to provide military field hospitals with medical supplies depends on the quality of medical care for the wounded and sick, as well as the level of their return to duty. The article presents the characteristics of modern standards medical supplies procurement of military field hospitals included in the new regulatory legal act of the Russian Federation Ministry of Defence--"Standards of supplies medical supplies medical and pharmaceutical organizations (units) of the Russian Federation on the wartime armed forces", approved and put into effect in 2015 by order of the Minister of Defence of the Russian Federation.

  7. PATTERN OF SURGICAL AND MEDICAL DISEASES AMONG PILGRIMS ATTENDING AL-NOOR HOSPITAL MAKKAH

    PubMed Central

    Al-Harbi, Mohammed A.

    2000-01-01

    Objective: Hajj usually presents a unique medical crisis especially for the Emergency Department. This study will identify the surgical and medical cases that presented at the Emergency Department during Hajj and percentage admitted. Design: A prospective study of the pattern of surgical and medical cases that presented at the Emergency Department of the largest tertiary care hospital in Makkah city and holy lands during Hajj. Methods: The study was conducted prospectively during the 1413 (1993) Hajj pilgrimage from 20.11.1413 to 20.12.1413. All Saudi and non-Saudi pilgrims presenting at the Emergency Department of Al-Noor Specialist Hospital were included. Results: From the 7,676 patients who came to the Emergency Department, 1426 were admitted. The commonest cause for surgical admission was trauma, while the commonest cause for medical admission was pneumonia. Conclusion: More than 50% of cases could have been dealt with in the Outpatient Department or Primary Health Care Centers. PMID:23008609

  8. [Oocyte donation after the bioethics law. Medical, ethical and legal implications drawn form a series of 300 cases at the Tenon hospital].

    PubMed

    Salat-Baroux, J; Cornet, D; Mandelbaum, J; Watanabe, Y; Merviel, P; Antoine, J M

    2001-01-01

    This is the perfect example of the problems which are the consequences of the actual medicine. We carried out an ovocyte donation study at the Tenon Hospital, in Paris, between 1994 and 1999 involving 177 cryopreserved thawed embryo transfers among 300 recipients. This study enables us to stress the ethical difficulties posed by the so called bioethical laws of 1994. Simultaneously two consequences became clearly evident: a paucity of donors, and the necessity to only transfer frozen embryos due to decree of 1996 upon sanitary security that imposes the quarantine of embryos for six months. On the other hand, the use of this method has yielded important new information regarding embryo implantation and the importance of ovocyte quality that is closely correlated to donor age.

  9. [Hospital clinical engineer orientation and function in the maintenance system of hospital medical equipment].

    PubMed

    Li, Bin; Zheng, Yunxin; He, Dehua; Jiang, Ruiyao; Chen, Ying; Jing, Wei

    2012-03-01

    The quantity of medical equipment in hospital rise quickly recent year. It provides the comprehensive support to the clinical service. The maintenance of medical equipment becomes more important than before. It is necessary to study on the orientation and function of clinical engineer in medical equipment maintenance system. Refer to three grade health care system, the community doctors which is called General practitioner, play an important role as the gatekeeper of health care system to triage and cost control. The paper suggests that hospital clinical engineer should play similar role as the gatekeeper of medical equipment maintenance system which composed by hospital clinical engineer, manufacture engineer and third party engineer. The hospital clinical engineer should be responsible of guard a pass of medical equipment maintenance quality and cost control. As the gatekeeper, hospital clinical engineer should take the responsibility of "General engineer" and pay more attention to safety and health of medical equipment. The responsibility description and future transition? development of clinical engineer as "General Engineer" is discussed. More attention should be recommended to the team building of hospital clinical engineer as "General Engineer".

  10. Responsibly managing the medical school--teaching hospital power relationship.

    PubMed

    Chervenak, Frank A; McCullough, Laurence B

    2005-07-01

    The relationship between medical schools and their teaching hospitals involves a complex and variable mixture of monopoly and monopsony power, which has not been previously been ethically analyzed. As a consequence, there is currently no ethical framework to guide leaders of both institutions in the responsible management of this complex power relationship. The authors define these two forms of power and, using economic concepts, analyze the nature of such power in the medical school-teaching hospital relationship, emphasizing the potential for exploitation. Using concepts from both business ethics and medical ethics, the authors analyze the nature of transparency and co-fiduciary responsibility in this relationship. On the basis of both rational self-interest, drawn from business ethics, and co-fiduciary responsibility, drawn from medical ethics, they argue for the centrality of transparency in the medical school-teaching hospital relationship. Understanding the ethics of monopoly and monopsony power is essential for the responsible management of the complex relationship between medical schools and their teaching hospitals and can assist the leadership of academic health centers in carrying out one of their major responsibilities: to prevent the exploitation of monopoly power and monopsony power in this relationship.

  11. Hospitalizations of adults with intellectual disability in academic medical centers.

    PubMed

    Ailey, Sarah H; Johnson, Tricia; Fogg, Louis; Friese, Tanya R

    2014-06-01

    Individuals with intellectual disability (ID) represent a small but important group of hospitalized patients who often have complex health care needs. Individuals with ID experience high rates of hospitalization for ambulatory-sensitive conditions and high rates of hospitalizations in general, even when in formal community care systems; however, no research was found on the common reasons for which this population is hospitalized. Academic medical centers often treat the most complex patients, and data from these centers can provide insight into the needs of patient populations with complex needs. The purpose of this study was to analyze descriptive data from the UHC (formerly known as the University Healthsystem Consortium; an alliance of 115 U.S. academic medical centers and 300 of their affiliated hospitals) regarding common reasons for hospitalization, need for intensive care, and common hospitalization outcome measures of length of stay and complications for adult (age ≥ 18) patients with ID. Findings indicate the need for specific attention to the needs of hospitalized patients with ID.

  12. Cat flea infestation in a hospital: a case report.

    PubMed

    Leelavathi, Muthupalaniappen; Norhayati, Moktar; Lee, Yin Yin

    2012-03-01

    Cat flea bite in humans results in extremely pruritic skin lesions. It has been reported to occur among those living in domiciliary accommodation. However, nosocomial infestation with cat flea has not been reported. We hereby report a case of nosocomial infestation of cat flea in a hospital facility. Identification of the parasite, its appropriate eradication, and adequate medical management of the patients resulted in a satisfactory outcome.

  13. Cat Flea Infestation in a Hospital: A Case Report

    PubMed Central

    Norhayati, Moktar; Lee, Yin Yin

    2012-01-01

    Cat flea bite in humans results in extremely pruritic skin lesions. It has been reported to occur among those living in domiciliary accommodation. However, nosocomial infestation with cat flea has not been reported. We hereby report a case of nosocomial infestation of cat flea in a hospital facility. Identification of the parasite, its appropriate eradication, and adequate medical management of the patients resulted in a satisfactory outcome. PMID:22451739

  14. Labor outcome of primigravidae in Mymensingh Medical College Hospital.

    PubMed

    Latif, T; Ali, M A; Majeed, A; Nahar, K; Noor, Z

    2013-07-01

    This cross sectional study was done in the department of Obstetrics and Gynae, Mymensingh Medical College Hospital, during the period 1st January to 30th June 2000 to evaluate the labor outcome in primigrvidae women. Total 1250 cases were delivered in this period. Among all 500(40%) were primigravidae. All the primigravidae were included and labor was monitored and managed by close observation. Condition of the baby was determined by applying APGAR (Appearance, Pulse, Grimace, Activity and Respiration) score. Maximum (66.6%) of patients were belonged to 21-29 years age group. Only few 28.2% had regular antenatal check-up. Risk factors were present in 32% cases. Common risk factors were PET (Pre-eclamptic toxemia) and eclampsia. Mode of deliveries were normal vaginal delivery (NVD) in (51.6%) cases, Lower Uterine Caesarean section (LUCS) in 43.8% cases, Ventouse in 2.8% cases, Forceps in 9(1.8%) cases and craniotomy was required in 2(0.4%) cases. Complications during labor were prolonged labor, postpartum hemorrhage, obstructed labor and perineal tear. PET was common (29.62%) in age group 30-36 years and eclampsia was more common (15%) in age group 16-20 years. NVD were more (55.85%) in 21-29 years group than other age group. The duration of labor pain was short in the age group of 21-29 years and was prolonged in the age group 30-36 years. Maternal mortality was 1.6% (8) cases. Causes of death were septic shock, renal failure and Cerebrovascullar accident. Morbidities after delivery were hypertension, wound infection, puerperal psychosis, acute renal failure, vesicovaginal fistula, hypertensive retinopathy, chronic ill health and retention of urine. Among 500 cases 92.6% were live born and 7.4% were still born. Among total cases 81.6% babies were healthy, 6.8% were asphyxiated, 71.2% had normal birth weight 21.4% had low birth weight, 18% were premature and 7.4% were IUGR. This study shows the safest and easiest delivery age group of primigravidae is between 21

  15. Health literacy and medication understanding among hospitalized adults.

    PubMed

    Marvanova, Marketa; Roumie, Christianne L; Eden, Svetlana K; Cawthon, Courtney; Schnipper, Jeffrey L; Kripalani, Sunil

    2011-11-01

    Patients' ability to accurately report their preadmission medications is a vital aspect of medication reconciliation, and may affect subsequent medication adherence and safety. Little is known about predictors of preadmission medication understanding. We conducted a cross-sectional evaluation of patients at 2 hospitals using a novel Medication Understanding Questionnaire (MUQ). MUQ scores range from 0 to 3 and test knowledge of the medication purpose, dose, and frequency. We used multivariable ordinal regression to determine predictors of higher MUQ scores. Among the 790 eligible patients, the median age was 61 (interquartile range [IQR] 52, 71), 21% had marginal or inadequate health literacy, and the median number of medications was 8 (IQR 5, 11). Median MUQ score was 2.5 (IQR 2.2, 2.8). Patients with marginal or inadequate health literacy had a lower odds of understanding their medications (odds ratio [OR] = 0.53; 95% confidence interval [CI], 0.34 to 0.84; P = 0.0001; and OR = 0.49; 95% CI, 0.31 to 0.78; P = 0.0001; respectively), compared to patients with adequate health literacy. Higher number of prescription medications was associated with lower MUQ scores (OR = 0.52; 95% CI, 0.36 to 0.75; for those using 6 medications vs 1; P = 0.0019), as was impaired cognitive function (OR = 0.57; 95% CI, 0.38 to 0.86; P = 0.001). Lower health literacy, lower cognitive function, and higher number of medications each were independently associated with less understanding of the preadmission medication regimen. Clinicians should be aware of these factors when considering the accuracy of patient-reported medication regimens, and counseling patients about safe and effective medication use. Copyright © 2011 Society of Hospital Medicine.

  16. [Functional changes to hospital laboratories and roles of medical technologists].

    PubMed

    Miyachi, Hayato

    2010-02-01

    During the last decade, laboratory medicine has been faced with marked changes in the health care environment. There is an increasing pressure to reduce costs and increase the efficiency and quality of medical care. In response, hospital laboratories need to undergo functional changes. Ongoing technological developments have markedly improved the productivity of laboratories and, thus, their information services. Currently, core competencies of hospital laboratories are shifting from an emphasis on information to knowledge services related to in vitro diagnostics. A key factor is to promote additional values of laboratory observations. Also, hospital laboratory services are shifting in aspect and field, from technical to clinic and from laboratory to near-patient, respectively, which are reflected in the recent upsurge in point-of-care testing and care delivery through an integrated team approach. To nurture medical technologists who meet such requirements of hospital laboratories, a continuous educational program is to be devised on a nationwide basis.

  17. The appropriateness of referral of medically compromised dental patients to hospital.

    PubMed

    Absi, E G; Satterthwaite, J; Shepherd, J P; Thomas, D W

    1997-04-01

    Hospital departments of oral and maxillofacial surgery make a substantial contribution to both managing and treating medically-compromised dental patients. Contracting arrangements should take account of this. Demographic data suggest that the treatment of medically-compromised elderly dentate patients will become increasingly important in the General Dental Service (GDS). To determine the medical conditions and treatment requirements prompting referral of these patients to hospital, a prospective study was undertaken of 75 consecutive adults referred for hospital treatment specifically because of a medical condition which prevented delivery of routine dental care in the GDS. Patients (mean age: 56 years) were referred mainly from general medical (33%) and dental (62%) practitioners. Cardiovascular disease was the most frequently cited medical condition requiring referral (43%; n = 32 cases). Forty-eight patients (64%) were symptomatic on presentation and on average had attended on 2.3 occasions before definitive treatment was instituted. Fifty-two patients (70%) had no special treatment requirements other than those available in the GDS, 11 patients (15%) simply required antibiotic prophylaxis and 81% were treated by undergraduates or junior staff. These data suggest that many patients referred for dental hospital treatment because of underlying medical condition are not in fact medically-compromised and may be treated in the primary care setting.

  18. Hospital program weds case, disease management.

    PubMed

    1997-10-01

    To lower its readmission rates and inpatient length of stay for three high-volume chronic conditions, Memorial Hospital in Colorado Springs, CO, developed a program that combines clinical pathways with a cross-continuum disease management program. Community physicians refer patients to the program. Hospital-based care managers guide patients in the acute setting before handing them off to outpatient case managers, who coordinate the patient's transition to home care. Clinicians at Memorial sold administrators on the "care-case management" approach by arguing that increased inpatient efficiency would offset potential revenue shortfalls due to fewer admissions.

  19. Medical identity theft: prevention and reconciliation initiatives at Massachusetts General Hospital.

    PubMed

    Judson, Timothy; Haas, Mark; Lagu, Tara

    2014-07-01

    Medical identity theft refers to the misuse of another individual's identifying medical information to receive medical care. Beyond the financial burden on patients, hospitals, health insurance companies, and government insurance programs, undetected cases pose major patient safety challenges. Inaccuracies in the medical record may persist even after the theft has been identified because of restrictions imposed by patient privacy laws. Massachusetts General Hospital (MGH; Boston) has conducted initiatives to prevent medical identity theft and to better identify and respond to cases when they occur. Since 2007, MGH has used a notification tree to standardize reporting of red flag incidents (warning signs of identity theft, such as suspicious personal identifiers or account activity). A Data Integrity Dashboard allows for tracking and reviewing of all potential incidents of medical identity theft to detect trends and targets for mitigation. An identity-checking policy, VERI-(Verify Everyone's Identity) Safe Patient Care, requires photo identification at every visit and follow-up if it is not provided. Data from MGH suggest that an estimated 120 duplicate medical records are created each month, 25 patient encounters are likely tied to identity theft or fraud each quarter, and 14 patients are treated under the wrong medical record number each year. As of December 2013, 80%-85% of patients were showing photo identification at appointments. Although an organization's policy changes and educational campaigns can improve detection and reconciliation of medical identity theft cases, national policies should be implemented to streamline the process of correcting errors in medical records, reduce the financial disincentive for hospitals to detect and report cases, and create a single point of entry to reduce the burden on individuals and providers to reconcile cases.

  20. Pharmacists' Interprofessional Communication About Medications in Specialty Hospital Settings.

    PubMed

    Rixon, Sascha; Braaf, Sandra; Williams, Allison; Liew, Danny; Manias, Elizabeth

    2015-01-01

    Effective communication between pharmacists, doctors, and nurses about patients' medications is particularly important in specialty hospital settings where high-risk medications are frequently used. This article describes the nature of communication about medications that occurs between pharmacists and other health professionals, including doctors and nurses, in specialty hospital settings. Semistructured interviews with, and participant observations of, pharmacists, nurses, and doctors were conducted in specialty settings of an Australian public, metropolitan teaching hospital. Twenty-one individuals working in the settings of emergency care, oncology care, intensive care, cardiothoracic care, and perioperative care were interviewed. In addition, participant observations of 56 individuals were conducted in emergency care, oncology care, intensive care, and cardiothoracic care. Detailed thematic analysis of the data was performed. Across all of the settings, pharmacy was less visible than medicine and nursing in terms of pharmacists' work performed, pharmacy documentation and resources, and pharmacists' physical visibility. Pharmacists, doctors, and nurses largely worked alongside one another rather than with each other. When collaboration occurred, the professional groups engaged in mostly reactive communication to accomplish specific medication tasks that needed completing. Interprofessional differences in attitudes toward medications and medication management communication behaviors were evident. Pharmacists need to engage in more proactive communication in order to reduce the risk of medication errors occurring.

  1. Interdisciplinary medication decision making by pharmacists in pediatric hospital settings: An ethnographic study.

    PubMed

    Rosenfeld, Ellie; Kinney, Sharon; Weiner, Carlye; Newall, Fiona; Williams, Allison; Cranswick, Noel; Wong, Ian; Borrott, Narelle; Manias, Elizabeth

    2017-03-22

    Children are particularly vulnerable to experiencing medication incidents in hospitals. Making sound medication decisions is therefore of paramount importance. Prior research has principally described pharmacists' role in reducing medication errors. There is a dearth of information about pharmacists' interactions with pediatric hospital staff across disciplines in resolving medication issues. The aim of this study was to examine interdisciplinary medication decision making by pharmacists in pediatric hospital settings. An ethnographic design was undertaken comprising observations, semi-structured interviews and focus groups. Audio-recorded data were analyzed thematically. The study was conducted in three wards of an Australian pediatric tertiary teaching hospital, comprising general surgical, gastroenterology, endocrinology, neurology, adolescent and rehabilitation settings. Pharmacists, registered nurses and doctors were recruited from diverse clinical wards following information sessions. Pharmacists were central to complex pediatric medication decision making, intervening about dosage, administration, drug interactions and authorities. Pharmacists proactively contacted doctors and nurses about prescribing issues; conversely, staff routinely approached pharmacists for medication advice. Pharmacists were perceived as medication experts, their extensive knowledge valued in resolving complex issues: when off-label medications were prescribed, when protocols were absent or ambiguous, where tension existed between protocol adherence and patient safety, and where patients on multiple medications were at risk of medication error. Pharmacists had strong relationships with doctors and nurses, which had a bearing on pharmacists' input in interventions. Furthermore, pharmacists identified prescribing errors through strategies, such as case note review and medication reconciliation, although the lack of emergency department pharmacists and limited after-hours staffing posed

  2. Medical practice, procedure manuals and the standardisation of hospital death.

    PubMed

    Hadders, Hans

    2009-03-01

    This paper examines how death is managed in a larger regional hospital within the Norwegian health-care. The central focus of my paper concerns variations in how healthcare personnel enact death and handle the dead patient. Over several decades, modern standardised hospital death has come under critique in the western world. Such critique has resulted in changes in the standardisation of hospital deaths within Norwegian health-care. In the wake of the hospice movement and with greater focus on palliative care, doors have gradually been opened and relatives of the deceased are now more often invited to participate. I explore how the medical practice around death along with the procedure manual of post-mortem care at Trondheim University Hospital has changed. I argue that in the late-modern context, standardisation of hospital death is a multidimensional affair, embedded in a far more comprehensive framework than the depersonalized medico-legal. In the late-modern Norwegian hospital, interdisciplinary negotiation and co-operation has allowed a number of different agendas to co-exist, without any ensuing loss of the medical power holder's authority to broker death. I follow Mol's notion of praxiographic orientation of the actor-network approach while exploring this medical practice.

  3. Medication reconciliation in patients hospitalized in a cardiology unit.

    PubMed

    Magalhães, Gabriella Fernandes; Santos, Gláucia Noblat de Carvalho; Santos, Gláucia Beisl Noblat de Carvalho; Rosa, Mário Borges; Noblat, Lúcia de Araújo Costa Beisl

    2014-01-01

    To compare drugs prescribed on hospital admission with the list of drugs taken prior to admission for adult patients admitted to a cardiology unit and to identify the role of a pharmacist in identifying and resolving medication discrepancies. This study was conducted in a 300 bed university hospital in Brazil. Clinical pharmacists taking medication histories and reconciling medications prescribed on admission with a list of drugs used prior to admission. Discrepancies were classified as justified (e.g., based on the pharmacotherapeutic guidelines of the hospital studied) or unintentional. Treatments were reviewed within 48 hours following hospitalization. Unintentional discrepancies were further classified according to the categorization of medication error severity. Pharmacists verbally contacted the prescriber to recommend actions to resolve the discrepancies. A total of 181 discrepancies were found in 50 patients (86%). Of these discrepancies, 149 (82.3%) were justified changes to the patient's home medication regimen; however, 32 (17.7%) discrepancies found in 24 patients were unintentional. Pharmacists made 31 interventions and 23 (74.2%) were accepted. Among unintentional discrepancies, the most common was a different medication dose on admission (42%). Of the unintentional discrepancies 13 (40.6%) were classified as error without harm, 11 (34.4%) were classified as error without harm but which could affect the patient and require monitoring, 3 (9.4%) as errors could have resulted in harm and 5 (15.6%) were classified as circumstances or events that have the capacity to cause harm. The results revealed a high number of unintentional discrepancies and the pharmacist can play an important role by intervening and correcting medication errors at a hospital cardiology unit.

  4. Medication Reconciliation in Patients Hospitalized in a Cardiology Unit

    PubMed Central

    Magalhães, Gabriella Fernandes; Santos, Gláucia Beisl Noblat de Carvalho; Rosa, Mário Borges; Noblat, Lúcia de Araújo Costa Beisl

    2014-01-01

    Objectives To compare drugs prescribed on hospital admission with the list of drugs taken prior to admission for adult patients admitted to a cardiology unit and to identify the role of a pharmacist in identifying and resolving medication discrepancies. Method This study was conducted in a 300 bed university hospital in Brazil. Clinical pharmacists taking medication histories and reconciling medications prescribed on admission with a list of drugs used prior to admission. Discrepancies were classified as justified (e.g., based on the pharmacotherapeutic guidelines of the hospital studied) or unintentional. Treatments were reviewed within 48 hours following hospitalization. Unintentional discrepancies were further classified according to the categorization of medication error severity. Pharmacists verbally contacted the prescriber to recommend actions to resolve the discrepancies. Results A total of 181 discrepancies were found in 50 patients (86%). Of these discrepancies, 149 (82.3%) were justified changes to the patient's home medication regimen; however, 32 (17.7%) discrepancies found in 24 patients were unintentional. Pharmacists made 31 interventions and 23 (74.2%) were accepted. Among unintentional discrepancies, the most common was a different medication dose on admission (42%). Of the unintentional discrepancies 13 (40.6%) were classified as error without harm, 11 (34.4%) were classified as error without harm but which could affect the patient and require monitoring, 3 (9.4%) as errors could have resulted in harm and 5 (15.6%) were classified as circumstances or events that have the capacity to cause harm. Conclusion The results revealed a high number of unintentional discrepancies and the pharmacist can play an important role by intervening and correcting medication errors at a hospital cardiology unit. PMID:25531902

  5. Factors associated with medication warning acceptance for hospitalized adults.

    PubMed

    Knight, Amy M; Falade, Olufunmilayo; Maygers, Joyce; Sevransky, Jonathan E

    2015-01-01

    Computerized provider order entry (CPOE) systems can warn clinicians ordering medications about potential allergic or adverse reactions, duplicate therapy, and interactions with other medications. Clinicians frequently override these warnings. Understanding the factors associated with warning acceptance should guide revisions to these systems. Increase understanding of the factors associated with medication warning acceptance. Retrospective study of all single-medication warnings generated in a CPOE system from October 2009 through April 2010. Academic medical center. All adult non-intensive care unit patients hospitalized during the study period. A total of 40,391 medication orders generated a single-medication warning during the 7-month study period. Of these warnings, 47% were duplicate warnings, 47% interaction warnings, 6% allergy warnings, 0.1% adverse reaction warnings, and 9.8% were repeated for the same patient, medication, and provider. Only 4% of warnings were accepted. In multivariate analysis, warning acceptance was positively associated with male patient gender, admission to a service other than internal medicine, caregiver status other than resident, parenteral medications, lower numbers of warnings, and allergy or adverse reaction warning types. Older patient age, longer length of stay, inclusion on the Institute for Safe Medication Practice's List of High Alert Medications, and interaction warning type were all negatively associated with warning acceptance. Medication warnings are rarely accepted. Acceptance is more likely when the warning is infrequently encountered, and least likely when it is potentially most important. Warning systems should be redesigned to increase their effectiveness for the sickest patients, the least experienced physicians, and the medications with the greatest potential to cause harm. © 2015 Society of Hospital Medicine.

  6. Hospital electronic medical record enterprise application strategies: do they matter?

    PubMed

    Fareed, Naleef; Ozcan, Yasar A; DeShazo, Jonathan P

    2012-01-01

    Successful implementations and the ability to reap the benefits of electronic medical record (EMR) systems may be correlated with the type of enterprise application strategy that an administrator chooses when acquiring an EMR system. Moreover, identifying the most optimal enterprise application strategy is a task that may have important linkages with hospital performance. This study explored whether hospitals that have adopted differential EMR enterprise application strategies concomitantly differ in their overall efficiency. Specifically, the study examined whether hospitals with a single-vendor strategy had a higher likelihood of being efficient than those with a best-of-breed strategy and whether hospitals with a best-of-suite strategy had a higher probability of being efficient than those with best-of-breed or single-vendor strategies. A conceptual framework was used to formulate testable hypotheses. A retrospective cross-sectional approach using data envelopment analysis was used to obtain efficiency scores of hospitals by EMR enterprise application strategy. A Tobit regression analysis was then used to determine the probability of a hospital being inefficient as related to its EMR enterprise application strategy, while moderating for the hospital's EMR "implementation status" and controlling for hospital and market characteristics. The data envelopment analysis of hospitals suggested that only 32 hospitals were efficient in the study's sample of 2,171 hospitals. The results from the post hoc analysis showed partial support for the hypothesis that hospitals with a best-of-suite strategy were more likely to be efficient than those with a single-vendor strategy. This study underscores the importance of understanding the differences between the three strategies discussed in this article. On the basis of the findings, hospital administrators should consider the efficiency associations that a specific strategy may have compared with another prior to moving toward

  7. Medical Image distribution and visualization in a hospital using CORBA.

    PubMed

    Moreno, Ramon Alfredo; do Santos, Marcelo; Bertozzo, Nivaldo; de Sa Rebelo, Marina; Furuie, Sergio S; Gutierrez, Marco A

    2008-01-01

    In this work it is presented the solution adopted by the Heart Institute (InCor) of Sao Paulo for medical image distribution and visualization inside the hospital's intranet as part of the PACS system. A CORBA-based image server was developed to distribute DICOM images across the hospital together with the images' report. The solution adopted allows the decoupling of the server implementation and the client. This gives the advantage of reusing the same solution in different implementation sites. Currently, the PACS system is being used on two different hospitals each one with three different environments: development, prototype and production.

  8. Medical emergency teams: deciphering clues to crises in hospitals

    PubMed Central

    DeVita, Michael

    2005-01-01

    Cardiac arrest in hospitals is usually preceded by prolonged deterioration. If the deterioration is recognized and treated, often death can be prevented. Medical emergency teams (MET) are a mechanism to fill this need. The epidemiology of patient deteriorations is not well understood. Jones and colleagues provide data regarding the temporal pattern of METs. They describe a diurnal variation to crises that strongly suggests hospital processes may systematically ignore (and find) patient deterioration. Hospitals in the future must develop methodologies to find more reliably patients who are in crisis, and then respond to them swiftly and effectively to prevent unnecessary deaths. PMID:16137372

  9. Medical emergency teams: deciphering clues to crises in hospitals.

    PubMed

    DeVita, Michael

    2005-08-01

    Cardiac arrest in hospitals is usually preceded by prolonged deterioration. If the deterioration is recognized and treated, often death can be prevented. Medical emergency teams (MET) are a mechanism to fill this need. The epidemiology of patient deteriorations is not well understood. Jones and colleagues provide data regarding the temporal pattern of METs. They describe a diurnal variation to crises that strongly suggests hospital processes may systematically ignore (and find) patient deterioration. Hospitals in the future must develop methodologies to find more reliably patients who are in crisis, and then respond to them swiftly and effectively to prevent unnecessary deaths.

  10. The impact of medical tourism on Thai private hospital management: informing hospital policy.

    PubMed

    James, Paul T J

    2012-01-01

    The purpose of this paper is to help consolidate and understand management perceptions and experiences of a targeted group (n=7) of Vice-Presidents of international Private Thai hospitals in Bangkok regarding medical tourism impacts. The method adopted uses a small-scale qualitative inquiry. Examines the on-going development and service management factors which contribute to the establishment and strengthening of relationships between international patients and hospital medical services provision. Develops a qualitative model that attempts to conceptualize the findings from a diverse range of management views into a framework of main (8) - Hospital Management; Hospital Processes; Hospital Technology; Quality Related; Communications; Personnel; Financial; and Patients; and consequent sub-themes (22). Outcomes from small-scale qualitative inquiries cannot by design be taken outside of its topical arena. This inevitably indicates that more research of this kind needs to be carried out to understand this field more effectively. The evidence suggests that Private Thai hospital management have established views about what constitutes the impact of medical tourism on hospital policies and practices when hospital staff interact with international patients. As the private health service sector in Thailand continues to grow, future research is needed to help hospitals provide appropriate service patterns and appropriate medical products/services that meet international patient needs and aspirations. Highlights the increasing importance of the international consumer in Thailand's health industry. This study provides insights of private health service providers in Bangkok by helping to understand more effectively health service quality environments, subsequent service provision, and the integrated development and impacts of new medical technology.

  11. The Impact of Medical Tourism on Thai Private Hospital Management: Informing Hospital Policy

    PubMed Central

    James, Paul TJ

    2012-01-01

    Background: The purpose of this paper is to help consolidate and understand management perceptions and experiences of a targeted group (n=7) of Vice-Presidents of international Private Thai hospitals in Bangkok regarding medical tourism impacts. Methods: The method adopted uses a small-scale qualitative inquiry. Examines the on-going development and service management factors which contribute to the establishment and strengthening of relationships between international patients and hospital medical services provision. Develops a qualitative model that attempts to conceptualise the findings from a diverse range of management views into a framework of main (8) - Hospital Management; Hospital Processes; Hospital Technology; Quality Related; Communications; Personnel; Financial; and Patients; and consequent sub-themes (22). Results: Outcomes from small-scale qualitative inquiries cannot by design be taken outside of its topical arena. This inevitably indicates that more research of this kind needs to be carried out to understand this field more effectively. The evidence suggests that Private Thai hospital management have established views about what constitutes the impact of medical tourism on hospital policies and practices when hospital staff interact with international patients. Conclusions: As the private health service sector in Thailand continues to grow, future research is needed to help hospitals provide appropriate service patterns and appropriate medical products/services that meet international patient needs and aspirations. Highlights the increasing importance of the international consumer in Thailand’s health industry. This study provides insights of private health service providers in Bangkok by helping to understand more effectively health service quality environments, subsequent service provision, and the integrated development and impacts of new medical technology. PMID:22980119

  12. [The costs of extreme values and case resolved in a public hospital from Iaşi, Romania].

    PubMed

    Bogdănici, Camelia; Bârliba, I

    2008-01-01

    For calculating the estimated costs for health care services in public hospitals from Romania case mixed index and mean of hospital duration are used especially. Medical insurance give for medical practice a fixed allowance based on a historical cost. For hospitals with severe cases there is necessary to introduce the term "extreme values, or cases" for improving the cost for intensive care units, for complicated cases.

  13. Engaging staff to improve quality and safety in an austere medical environment: a case-control study in two Sierra Leonean hospitals.

    PubMed

    Rosen, Michael A; Chima, Adaora M; Sampson, John B; Jackson, Eric V; Koka, Rahul; Marx, Megan K; Kamara, Thaim B; Ogbuagu, Onyebuchi U; Lee, Benjamin H

    2015-08-01

    Inadequate observance of basic processes in patient care such as patient monitoring and documentation practices are potential impediments to the timely diagnoses and management of patients. These gaps exist in low resource settings such as Sierra Leone and can be attributed to a myriad of factors such as workforce and technology deficiencies. In the study site, only 12.4% of four critical vital signs were documented in the pre-intervention period. Implement a failure mode and effects analysis (FMEA) to improve documentation of four patient vital signs: temperature, blood pressure, pulse rate and respiratory rate. FMEA was implemented among a subpopulation of health workers who are involved in monitoring and documenting patient vital signs. Pre- and post-FMEA monitoring and documentation practice were compared with a control site. Participants identified a four-step process to monitoring and documenting vital signs, three categories of failure modes and four potential solutions. Based on 2100 patient days of documentation compliance data from 147 patients between July and November 2012, staff members at the study site were 1.79 times more likely to document all four patient vital signs in the post-implementation period (95% CI [1.35, 2.38]). FMEA is a feasible and effective strategy for improving quality and safety in an austere medical environment. Documentation compliance improved at the intervention facility. To evaluate the scalability and sustainability of this approach, programs targeting the development of these types of process improvement skills in local staff should be evaluated. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

  14. The Hospital Medical Advisory Committee—The Cabinet of the Medical Staff

    PubMed Central

    Williams, K. J.; Osbaldeston, J. B.

    1965-01-01

    Before a hospital medical staff can realistically accept responsibility for the professional practices of its members, a principle initially fostered by the American College of Surgeons and adopted by both the Canadian and American accreditation programs, it must have an effectively functioning medical staff organization. The medical advisory committee is the most important committee of the medical staff organization. A representative composition, adherence to sound administrative principles, and recognition of its prime functions of co-ordination, supervision and jurisdiction will permit this committee—and the total medical staff organization—to discharge adequately the very important responsibilities delegated to them by the governing board of the hospital. Properly structured medical staff bylaws with clearly defined terms of reference assist the smooth functioning of the “cabinet” of the medical staff and safeguard the prerogatives of the individual members of the staff. PMID:14285296

  15. THE HOSPITAL MEDICAL ADVISORY COMMITTEE--THE CABINET OF THE MEDICAL STAFF.

    PubMed

    WILLIAMS, K J; OSBALDESTON, J B

    1965-05-22

    Before a hospital medical staff can realistically accept responsibility for the professional practices of its members, a principle initially fostered by the American College of Surgeons and adopted by both the Canadian and American accreditation programs, it must have an effectively functioning medical staff organization. The medical advisory committee is the most important committee of the medical staff organization. A representative composition, adherence to sound administrative principles, and recognition of its prime functions of co-ordination, supervision and jurisdiction will permit this committee-and the total medical staff organization-to discharge adequately the very important responsibilities delegated to them by the governing board of the hospital. Properly structured medical staff bylaws with clearly defined terms of reference assist the smooth functioning of the "cabinet" of the medical staff and safeguard the prerogatives of the individual members of the staff.

  16. Spreading a medication administration intervention organizationwide in six hospitals.

    PubMed

    Kliger, Julie; Singer, Sara; Hoffman, Frank; O'Neil, Edward

    2012-02-01

    Six hospitals from the San Francisco Bay Area participated in a 12-month quality improvement project conducted by the Integrated Nurse Leadership Program (INLP). A quality improvement intervention that focused on improving medication administration accuracy was spread from two pilot units to all inpatient units in the hospitals. INLP developed a 12-month curriculum, presented in a combination of off-site training sessions and hospital-based training and consultant-led meetings, to teach clinicians the key skills needed to drive organizationwide change. Each hospital established a nurse-led project team, as well as unit teams to address six safety processes designed to improve medication administration accuracy: compare medication to the medication administration record; keep medication labeled throughout; check two patient identifications; explain drug to patient (if applicable); chart immediately after administration; and protect process from distractions and interruptions. From baseline until one year after project completion, the six hospitals improved their medication accuracy rates, on average, from 83.4% to 98.0% in the spread units. The spread units also improved safety processes overall from 83.1% to 97.2%. During the same time, the initial pilot units also continued to improve accuracy from 94.0% to 96.8% and safety processes overall from 95.3% to 97.2%. With thoughtful planning, engaging those doing the work early and focusing on the "human side of change" along with technical knowledge of improvement methodologies, organizations can spread initiatives enterprisewide. This program required significant training of frontline workers in problem-solving skills, leading change, team management, data tracking, and communication.

  17. Changes in Hospital Competitive Strategy: A New Medical Arms Race?

    PubMed Central

    Devers, Kelly J; Brewster, Linda R; Casalino, Lawrence P

    2003-01-01

    Objective To describe changes in hospitals' competitive strategies, specifically the relative emphasis placed on strategies for competing along price and nonprice (i.e., service, amenities, perceived quality) dimensions, and the reasons for any observed shifts. Methods This study uses data gathered through the Community Tracking Study site visits, a longitudinal study of a nationally representative sample of 12 U.S. communities. Research teams visited each of these communities every two years since 1996 and conducted between 50 to 90 semistructured interviews. Additional information on hospital competition and strategy was gathered from secondary data. Principal Findings We found that hospitals' strategic emphasis changed significantly between 1996–1997 and 2000–2001. In the mid-1990s, hospitals primarily competed on price through “wholesale” strategies (i.e., providing services attractive to managed care plans). By 2000–2001, nonprice competition was becoming increasingly important and hospitals were reviving “retail” strategies (i.e., providing services attractive to individual physicians and the patients they serve). Three major factors explain this shift in hospital strategy: less than anticipated selective contracting and capitated payment; the freeing up of hospital resources previously devoted to horizontal and vertical integration strategies; and, the emergence and growth of new competitors. Conclusion Renewed emphasis on nonprice competition and retail strategies, and the service mimicking and one-upmanship that result, suggest that a new medical arms race is emerging. However, there are important differences between the medical arms race today and the one that occurred in the 1970s and early 1980s: the hospital market is more concentrated and price competition remains relatively important. The development of a new medical arms race has significant research and policy implications. PMID:12650375

  18. Facilitators and obstacles in pre-hospital medical response to earthquakes: a qualitative study

    PubMed Central

    2011-01-01

    Background Earthquakes are renowned as being amongst the most dangerous and destructive types of natural disasters. Iran, a developing country in Asia, is prone to earthquakes and is ranked as one of the most vulnerable countries in the world in this respect. The medical response in disasters is accompanied by managerial, logistic, technical, and medical challenges being also the case in the Bam earthquake in Iran. Our objective was to explore the medical response to the Bam earthquake with specific emphasis on pre-hospital medical management during the first days. Methods The study was performed in 2008; an interview based qualitative study using content analysis. We conducted nineteen interviews with experts and managers responsible for responding to the Bam earthquake, including pre-hospital emergency medical services, the Red Crescent, and Universities of Medical Sciences. The selection of participants was determined by using a purposeful sampling method. Sample size was given by data saturation. Results The pre-hospital medical service was divided into three categories; triage, emergency medical care and transportation, each category in turn was identified into facilitators and obstacles. The obstacles identified were absence of a structured disaster plan, absence of standardized medical teams, and shortage of resources. The army and skilled medical volunteers were identified as facilitators. Conclusions The most compelling, and at the same time amenable obstacle, was the lack of a disaster management plan. It was evident that implementing a comprehensive plan would not only save lives but decrease suffering and enable an effective praxis of the available resources at pre-hospital and hospital levels. PMID:21575233

  19. LIFENET hospitals (India): developing new services' case study.

    PubMed

    Rahman, Zillur; Qureshi, M N

    2008-01-01

    Indian healthcare is in the process of offering a plethora of services to customers hailing largely from India and from neighboring countries. The Indian hospital sector consists of private "nursing homes" and government and charitable missionary hospitals. Government and missionary hospitals determine their charges according to patients' income levels and treat poor patients freely. Nursing homes charged higher, market-determined rates. They offer services in just a few medical specialties, owned and operated by physicians who worked with them. Nursing homes cannot afford the latest medical technology, but they provide more intimate settings than government hospitals. This case study aims to demonstrate the various strategic options available to a for-profit hospital, in an emerging economy with a burgeoning middle-class population and how it can choose which services that it can best offer to its target population. Diagnosing and treating complex ailments in nursing homes could be a time-consuming and expensive proposition as visits to several nursing homes with different specialties may be necessary. This paper demonstrates how an hospital can develop new customer-oriented services and eliminate the hassle for patients needing to run around different healthcare outlets even for minor ailments. The paper finds that large government hospitals generally have better facilities than nursing homes, but they were widely believed to provide poor-quality care. They failed to keep up with advanced equipment, train their technicians adequately and did not publicize their capabilities to doctors who might refer patients. Many missionary and charitable hospitals were undercapitalized and did not offer all services. These conditions left an unsatisfied demand for high-quality medical care. In 1983, LIFENET opened in Madras, becoming the first comprehensive, for-profit hospital in India. LIFENET, invested in a cardiology laboratory and clinics with capacity to diagnose heart

  20. Development of instruction in hospital electrical safety for medical education.

    PubMed

    Yoo, J H; Broderick, W A

    1978-01-01

    Although hospital electrical safety is receiving increased attention in the literature of engineers, it is not, at present, reflected in the curricula of medical schools. A possible reason for this omission is that biomedical and/or clinical engineers knowledgeable in electrical safety are not usually trained to teach. One remedy for this problem is to combine the knowledge of engineers with that of instructional developers to design a systematic curriculum for a course in hospital electrical safety. This paper describes such an effort at the University of Texas Health Science Center at San Antonio (UTHSCSA). A biomedical engineer and an instructional developer designed an instructional module in hospital electrical safety; the engineer taught the module, and both evaluated the results. The process and outcome of their collaboration are described. This model was effectively applied in the classroom as a four-hour segment in hospital electrical safety for first-year medical students at UTHSCSA. It is hoped that an additional benefit of this system will be that it offers an opportunity for continuing improvement in this kind of instruction at other medical schools and hospitals.

  1. [Integration of activities of regional hospitals and territorial medical institutions].

    PubMed

    Murtazin, Z Ia; Blokhin, A B

    2000-01-01

    Medical and economic efficiency of regional therapeutic and prophylactic institutions is to develop in integration with therapeutic and prophylactic institutions of administrative territories of a subject of the federation, which necessitates modifications in the functions and organizational structure of organization and methodology departments of regional, central, and municipal hospitals.

  2. Medical Information Management System (MIMS): An automated hospital information system

    NASA Technical Reports Server (NTRS)

    Alterescu, S.; Simmons, P. B.; Schwartz, R. A.

    1971-01-01

    An automated hospital information system that handles all data related to patient-care activities is described. The description is designed to serve as a manual for potential users, nontechnical medical personnel who may use the system. Examples of the system's operation, commentary on the examples, and a complete listing of the system program are included.

  3. Academic Medical Centers and Community Hospitals Integration: Trends and Strategies.

    PubMed

    Fleishon, Howard B; Itri, Jason N; Boland, Giles W; Duszak, Richard

    2017-01-01

    Academic medical centers are widely recognized as vital components of the American health care system, generally differentiated from their community hospital peers by their tripartite mission of clinical care, education, and research. Community hospitals fill a critical and complementary role, serving as the primary sites for health care in most communities. Health care reform initiatives and economic pressures have created incentives for hospitals and health systems to integrate, resulting in a nationwide trend toward consolidation with academic medical centers leveraging their substantial assets to merge, acquire, or establish partnerships with their community peers. As these alliances accelerate, they have and will continue to affect the radiology groups providing services at these institutions. A deeper understanding of these new marketplace dynamics, changing relationships and potential strategies will help both academic and private practice radiologists adapt to this ongoing change. Copyright © 2016. Published by Elsevier Inc.

  4. On the measurement of hospital case mix.

    PubMed

    Klastorin, T D; Watts, C A

    1980-06-01

    This article discusses a number of issues related to the measurement of hospital diagnostic case mix. We initially examine a number of previous attempts to measure case mix based on surrogate measures (e.g., facilities and services) and information from predetermined discharge-classification systems. Since a number of researchers have attempted to reduce diagnostic classification data into a single-valued (i.e., scalar) case mix index, we then discuss a number of concepts and assumptions implicit in the construction of such indices. Among these assumptions is the property of functional homogeneity; this property and a methodology baed on Q-type factor analysis for testing for the presence of this property are defined. In order to illustrate the use of the methodology, it is applied to data from 153 hospitals in downstate New York.

  5. Medication dispensing errors at a public pediatric hospital.

    PubMed

    Costa, Lindemberg Assunção; Valli, Cleidenete; Alvarenga, Angra Pimentel

    2008-01-01

    assess the safety of medication dispensing processes through the dispensing error rate. Cross-sectional study carried out at a pharmaceutical service of a pediatric hospital in Espírito Santo, Brazil. Data collection was performed between August and September 2006, totaling 2620 prescribed medication doses. Any deviation from the medical prescription in dispensing medication was considered a dispensing error. THE CATEGORIES OF MEDICATION ERRORS WERE: content, labeling, and documentation errors. The dispensing error rate was computed by dividing the number of errors by the total of dispensed doses. From the 300 identified errors, 262 (87.3 %) were content errors. The rate of errors in the labeling and documentation categories was 33 (11%) and 5 (1.7%), respectively. The total dispensing error rate was higher than rates reported in international studies. The most frequent category was "content error".

  6. Post-Hospital Medical Respite Care and Hospital Readmission of Homeless Persons

    PubMed Central

    Kertesz, Stefan G.; Posner, Michael A.; O’Connell, James J.; Swain, Stacy; Mullins, Ashley N.; Michael, Shwartz; Ash, Arlene S.

    2009-01-01

    Medical respite programs offer medical, nursing, and other care as well as accommodation for homeless persons discharged from acute hospital stays. They represent a community-based adaptation of urban health systems to the specific needs of homeless persons. This paper examines whether post-hospital discharge to a homeless medical respite program was associated with a reduced chance of 90-day readmission compared to other disposition options. Adjusting for imbalances in patient characteristics using propensity scores, Respite patients were the only group that was significantly less likely to be readmitted within 90 days compared to those released to Own Care. Respite programs merit attention as a potentially efficacious service for homeless persons leaving the hospital. PMID:19363773

  7. Post-hospital medical respite care and hospital readmission of homeless persons.

    PubMed

    Kertesz, Stefan G; Posner, Michael A; O'Connell, James J; Swain, Stacy; Mullins, Ashley N; Shwartz, Michael; Ash, Arlene S

    2009-01-01

    Medical respite programs offer medical, nursing, and other care as well as accommodation for homeless persons discharged from acute hospital stays. They represent a community-based adaptation of urban health systems to the specific needs of homeless persons. This article examines whether post-hospital discharge to a homeless medical respite program was associated with a reduced chance of 90-day readmission compared to other disposition options. Adjusting for imbalances in patient characteristics using propensity scores, respite patients were the only group that was significantly less likely to be readmitted within 90 days compared to those released to Own Care. Respite programs merit attention as a potentially efficacious service for homeless persons leaving the hospital.

  8. Drug-related problems among medical ward patients in Jimma university specialized hospital, Southwest Ethiopia

    PubMed Central

    Tigabu, Bereket Molla; Daba, Daniel; Habte, Belete

    2014-01-01

    Objective: The increasing number of available drugs and drug users, as well as more complex drug regimens led to more side effects and drug interactions and complicates follow-up. The objective of this study was to assess drug-related problems (DRPs) and associated factors in hospitalized patients. Methods: A hospital-based cross-sectional study design was employed. The study was conducted in Jimma University Specialized Hospital, Jimma, located in the south west of Addis Ababa. All patients who were admitted to the medical ward from February 2011 to March 2011 were included in the study. Data on sociodemographic variables, past medical history, drug history, current diagnosis, current medications, vital signs, and relevant laboratory data were collected using semi-structured questionnaire and data collection forms which were filling through patient interview and card review. Data were analyzed using SPSS version 16 for windows. Descriptive statistics, cross-tabs, Chi-square, and logistic regression were utilized. Findings: Out of 257 study participants, 189 (73.5%) had DRPs and a total of 316 DRPs were identified. From the six classes of DRPs studied, 103 (32.6%) cases related to untreated indication or need additional drug therapy, and 49 (15.5%) cases related to high medication dosage. Unnecessary drug therapy in 49 (15.5%) cases, low medication dosage in 44 (13.9%) cases, and ineffective drug therapy in 42 (13.3%) cases were the other classes of problems identified. Noncompliance in 31 (9.8%) cases was the least prevalent DRP. Independent factors which predicted the occurrence of DRPs in the study population were sex, age, polypharmacy, and clinically significant potential drug-drug interactions. The prevalence of DRPs was substantially high (73.5%). Conclusion: Drug-related problems are common among medical ward patients. Indication-related problems, untreated indication and unnecessary drug therapy were the most common types of DRPs among patients of our

  9. Medical emergencies in the imaging department of a university hospital: event and imaging characteristics.

    PubMed

    van Tonder, F C; Sutherland, T; Smith, R J; Chock, J M E; Santamaria, J D

    2013-01-01

    We aimed to describe the characteristics of medical emergencies that occurred in the medical imaging department (MID) of a university hospital in Melbourne, Australia. A database of 'Respond Medical Emergency Team (MET)' and 'Respond Blue' calls was retrospectively examined for the period June 2003 to November 2010 in relation to events that occurred in the MID. The hospital medical imaging database was also examined in relation to these events and, where necessary, patients' notes were reviewed. Ethics approval was granted by the hospital ethics review board. There were 124 medical emergency calls in the MID during the study period, 28% Respond Blue and 72% Respond MET. Of these 124 calls, 26% occurred outside of usual work hours and 12% involved cardiac arrest. The most common reasons for the emergency calls were seizures (14%) and altered conscious state (13%). Contrast anaphylaxis precipitated the emergency in 4% of cases. In 83% of cases the emergency calls were for patients attending the MID for diagnostic imaging, the remainder being for a procedure. Of the scheduled imaging techniques, 45% were for computed tomography. The scheduled imaging was abandoned due to the emergency in 12% of cases. When performed, imaging informed patient management in 34% of cases in diagnostic imaging and in all cases in the context of image-guided procedures. Medical emergency calls in the MID often occurred outside usual work hours and were attributed to a range of medical problems. The emergencies occurred in relation to all imaging techniques and imaging informed patient management in many cases. Crown Copyright © 2012. Published by Elsevier Ireland Ltd. All rights reserved.

  10. Mental hospital reform in Asia: the case of Yuli Veterans Hospital, Taiwan

    PubMed Central

    Lin, Chih-Yuan; Huang, Ai-Ling; Minas, Harry; Cohen, Alex

    2009-01-01

    Background Yuli Veterans Hospital (YVH) has been the largest mental hospital for the patients with chronic and severe mental illness in Taiwan for the past 50 years. While this hospital used to be a symbol of hopelessness among patients and their families and an unspoken shame among Taiwan psychiatry and mental health circles it now represents an example of how an old, custodial hospital can be transformed into a very different institution. In this case study we will describe the features of this transformation, which, over the past 20 years, has aimed to help extended stay inpatients with severe mental illness to integrate into the local community of Yuli even though it is not their original home. Methods Using historical documents and oral narratives from Yuli inhabitants, workers and patients of YVH, we will offer a case study of the Yuli model. Results There are four main components of the Yuli model: holistic medical support, vocational rehabilitation, case management, and the residential program. The four components help patients recover two essential features of their lives: vocational life and ordinary daily routines. As the process of recovery evolves, patients gradually regain inner stability, dignity, self-confidence, and a sense of control. The four components are critical to rebuild the structure and order of life of the patients and are indispensable and interdependent parts of one service package. They operate simultaneously to benefit the patients to the greatest degree possible. Discussion There are many challenges to the further development and financial viability of the model of services developed at YVH. There are also important questions concerning the replicability of the Yuli model in other sociocultural and service system contexts. Conclusion This case study reveals the possibility of transforming a custodial mental hospital into a hospital providing high quality care. Hospital and community are not in opposition. They are part of a

  11. [A score to predict medical emergencies in hospitalized patients].

    PubMed

    Cofré, Claudia; Cavada, Gabriel; Maquilón, César; Daza, Paula; Vargas, Ángel; Vukusich, Antonio

    2017-02-01

    The medical alert system (MAS) was created for the timely handling of clinical decompensations, experienced by patients hospitalized at the Medical Surgical Service (MSS) in a private clinic. It is activated by the nurse when hemodynamic, respiratory, neurological, infectious or metabolic alterations appear, when a patient falls or complains of pain. A physician assesses the patient and decides further therapy. To analyze the clinical and demographic characteristics of patients who activated or not the MAS and develop a score to identify patients who will potentially activate MAS. Data from 13,933 patients discharged from the clinic in a period of one year was analyzed. MAS was activated by 472 patients (3.4%). Twenty two of these patients died during hospital stay compared to 68 patients who did not activate the alert (0.5%, p < 0.01). The predictive score developed considered age, diagnosis (based on the tenth international classification of diseases) and whether the patient was medical or surgical. The score ranges from 0 to 9 and a cutoff ≥ 6 provides a sensitivity and specificity of 37 and 81% respectively and a positive likelihood ratio (LR+) of 1.9 to predict the activation of MAS. The same cutoff value predicts death with a sensitivity and specificity of 80% and a negative predictive value of 99.8%. This score may be useful to identify hospitalized patients who may have complications during their hospital stay.

  12. [Case-mix index and length of hospitalization].

    PubMed

    D'Andrea, V; Catania, A; Di Matteo, F M; Savino, G; Greco, R; Di Marco, C; De Antoni, E

    2010-05-01

    The ACG (Adjusted Clinical Groups) case-mix system is a classification method of diseases of patients, focused on the person. Depending on the pattern of these morbid conditions, the ACG system assigns each patient to a single group (an ACG group), which allows to capture the effects of a group of diseases in estimates of resource use. Diseases are classified into a diagnostic group (ADG) according to 5 clinical dimensions: duration (acute, recurrent or chronic), severity (minor/major vs stable/unstable), diagnostic assessment (symptoms vs diseases), etiology (infectious, traumatic or other), specialty (medical, surgical, obstetric, ...). All diseases can be classified into these dimensions and into one of 32 groups. The ACG case-mix system uses an algorithm to classify each patient into one of 93 ACG categories. Each person is assigned to an ACG according to his ADG combination, his age and his gender. With the repayment system "case-mix", surgery has become central for all great hospitals in virtue of its great productive potential. The case-mix index is one of the factors which influence the duration of hospitalization. The case-mix system has emphasized the importance of the duration of hospitalization, encouraging the planning of programs in order to discharge patients early after surgical operations. It has also stimulated the surgical activity in operating units with "budget" forecasts in which resources are provided according to an expected level of specialist surgery.

  13. Relevance of the electronic computer to hospital medical records*

    PubMed Central

    Mitchell, J. H.

    1969-01-01

    During the past 30 years an “information explosion” has completely changed patterns of illness. Unit files of individual patients have become so large that they are increasingly difficult both to store physically and to assimilate mentally. We have reached a communications barriers which poses a major threat to the efficient practice of clinical medicine. At the same time a new kind of machine, the electronic digital computer, which was invented only 26 years ago, has already come to dominate large areas of military, scientific, commercial, and industrial activity. Its supremacy rests on its ability to perform any data procedure automatically and incredibly quickly. Computers are being employed in clinical medicine in hospitals for various purposes. They can act as arithmetic calculators, they can process and analyse output from recording devices, and they can make possible the automation of various machine systems. However, in the field of case records their role is much less well defined, for here the organization of data as a preliminary to computer input is the real stumbling-block. Data banks of retrospective selected clinical information have been in operation in some centres for a number of years. Attempts are now being made to design computerized “total information systems” to replace conventional paper records, and the possibility of automated diagnosis is being seriously discussed. In my view, however, the medical profession is in danger of being dazzled by optimistic claims about the usefulness of computers in case record processing. The solution to the present problems of record storage and handling is very simple, and does not involve computerization. PMID:4898564

  14. Risk assessment - hospital view in selecting medical technology.

    PubMed

    David, Yadin; Jahnke, Ernest; Blair, Curtis

    2004-01-01

    Appropriate deployment of technological innovation contributes to improvement in the quality of healthcare delivered, the containment of cost, and access to the healthcare system. Hospitals have been allocating a significant portion of their resources to procuring and managing capital assets; they are continuously faced with demands for new medical equipment and are asked to manage existing inventory for which they are not well prepared. To objectively direct their investment, hospitals are developing medical technology management programs that need pertinent information and planning methodology for integrating new equipment into existing operations as well as for mitigating patient safety issues and costs of ownership. Clinical engineers identify technological solutions based on the matching of new medical equipment with hospital's objectives. They review their institution's overall technological position, determine strengths and weaknesses, develop equipment-selection criteria, supervise installations, train users and monitor post procurement performance to assure meeting of goals. This program, together with consistent assessment methodology and evaluation analysis, will objectively guide the capital assets decision-making process. At Texas Children's Hospital we integrated engineering simulation, bench testing and clinical studies with financial information to assure the validity of risk avoidance practice and the promotion of medical equipment and supplies selection based on quantitative measurement process and product comparison practice. The clinical engineer's skills and expertise are needed to facilitate the adoption of an objective methodology for implementing the program, thus improving the match between the hospital's needs and budget projections, equipment performance and cost of ownership. The result of systematic planning and execution is a program that assures the safety and appropriateness of inventory level at the lowest life-cycle costs at the

  15. Implementation of Single Source Based Hospital Information System for the Catholic Medical Center Affiliated Hospitals

    PubMed Central

    Choi, Inyoung; Choi, Ran; Lee, Jonghyun

    2010-01-01

    Objectives The objective of this research is to introduce the unique approach of the Catholic Medical Center (CMC) integrate network hospitals with organizational and technical methodologies adopted for seamless implementation. Methods The Catholic Medical Center has developed a new hospital information system to connect network hospitals and adopted new information technology architecture which uses single source for multiple distributed hospital systems. Results The hospital information system of the CMC was developed to integrate network hospitals adopting new system development principles; one source, one route and one management. This information architecture has reduced the cost for system development and operation, and has enhanced the efficiency of the management process. Conclusions Integrating network hospital through information system was not simple; it was much more complicated than single organization implementation. We are still looking for more efficient communication channel and decision making process, and also believe that our new system architecture will be able to improve CMC health care system and provide much better quality of health care service to patients and customers. PMID:21818432

  16. [Hospital response and medical management in toxic chemical substance disasters].

    PubMed

    Yeh, I-Jeng; Lin, Tzeng-Jih

    2010-06-01

    A hazardous material is defined as any item or agent which has the potential to cause harm to humans, animals, or the environment, either by itself or through interaction with other factors. Toxic chemical substance events are increasingly common events in our modern world. The numerous variables and special equipment involved make effective response to toxic chemical events an especially critical test of hospital emergency response and patient rescue mechanisms. Inadequacies in management could result in disaster - even when only a simple event and minimal error are involved. This article introduces the general medical management algorithm for toxic chemical substance injury and the hospital incident command systems (HICS) developed and currently used by Taiwanese hospitals. Important steps and frequent mistakes made during medical management procedures are further described. The goal of medical care response and emergency units is to prevent catastrophic disasters in the emergency room and their subsequent results. This article further emphasizes correct patient management not only in terms of medical unit effort, but also in terms of cooperation between various relevant organizations including factory-based industrial health and safety systems, multi-factory union defense systems, coordination centers, fire protection and disaster rescue systems, the Environmental Protection Administration and national defense system in order to achieve the most appropriate management. Such coordination, in particular, requires reinforcement in order to ensure readiness for future response needs.

  17. Seizure occurrence following nonoptimal anticonvulsant medication management during the transition into the hospital.

    PubMed

    Jones, Charlotte; Kaffka, Jaimee; Missanelli, Megan; Dure, Leon; Ness, Jayne; Funkhouser, Ellen; Kilgore, Meredith; Yu, Feliciano; Safford, Monika M; Saag, Kenneth

    2013-10-01

    Previous work has shown that medication errors related to anticonvulsants are common during the transition into the hospital for pediatric patients. The purpose of this work was to evaluate whether children with epilepsy admitted for reasons other than epilepsy experience nonoptimal care in anticonvulsant medication management preceding the occurrence of seizures. Using a retrospective cohort of children with epilepsy admitted for reasons other than epilepsy, we created timelines from data in the medical record for the children who experienced seizures. These timelines included the timing and concentration of anticonvulsant administration and seizure occurrence. Three child neurologists independently identified whether nonoptimal care preceded the occurrence of seizures and potentially contributed to the occurrence of the seizure. Of 120 children, 18 experienced seizures and 12 experienced nonoptimal care in anticonvulsant management preceding seizure occurrence. Nonoptimal care that occurred during the transition into the hospital included missed doses of anticonvulsants, delays in administration during which seizures occurred, and patients inadvertently not receiving their home dosing of medication. Anticonvulsant medication errors are known to occur during the transition into the hospital. Here we present a case series of children who experienced nonoptimal care in anticonvulsant medication management who subsequently experienced seizures. Further work to identify how likely the outcome of seizures is following anticonvulsant medication errors, specifically focusing on timing as well as interventions to change the system issues that lead to these errors, is indicated.

  18. Inter-hospital transfers from rural hospitals to an academic medical center.

    PubMed

    Nair, Dilip; Gibbs, Mary M

    2013-01-01

    The need for inter-hospital patient transfers from rural hospitals, especially Critical Access Hospitals, to larger, more urban hospitals is predictable considering the limited resources at rural hospitals. No systematic study of the inter-hospital transfers themselves has been published. The aim of this retrospective descriptive chart review was to provide a preliminary look at inter-hospital transfers from rural hospitals to a more urban, academic medical center in West Virginia. Ultimately, the creation of an agenda for further research was in view. A list of study participants was generated from the academic center's electronic health record database. Study participants were patients who had been transferred for acute care, from November 2011 through June 2012, to the receiving hospital from another acute care hospital and had been under the care of the family medicine teaching service. One hundred and thirty-eight patient transfers were included. Medicare was the most common source of health insurance coverage but over a third of the patients were uninsured. Only five of the twenty-four referring hospitals were Critical Access Hospitals. Four institutions alone initiated 49.3% of transfers. Nineteen specialty services were sought with critical care and neurology accounting for 53.9% of requests. Stroke or stroke-like presentation was the most common transfer diagnosis. 24.6% of transfers were transferred for services that were available at the transferring facility. This study has suggested an agenda for further research that includes replication and analysis of the data with larger study samples as well as qualitative research into the transferring physicians' decision-making process.

  19. Improving medical records filing in a municipal hospital in Ghana.

    PubMed

    Teviu, E A A; Aikins, M; Abdulai, T I; Sackey, S; Boni, P; Afari, E; Wurapa, F

    2012-09-01

    Medical records are kept in the interest of both the patient and clinician. Proper filing of patient's medical records ensures easy retrieval and contributes to decreased patient waiting time at the hospital and continuity of care. This paper reports on an intervention study to address the issue of misfiling and multiple patient folders in a health facility. Intervention study. Municipal Hospital, Goaso, Asunafo North District, Brong Ahafo Region, Ghana. Methods employed for data collection were records review, direct observation and tracking of folders. Interventions instituted were staff durbars, advocacy and communication, consultations, in-service trainings, procurement and monitoring. Factors contributing to issuance of multiple folders and misfiling were determined. Proportion of multiple folders was estimated. Results revealed direct and indirect factors contributing to issuance of multiple patient folders and misfiling. Interventions and monitoring reduce acquisition of numerous medical folders per patient and misfiling. After the intervention, there was significant reduction in the use of multiple folders (i.e., overall 97% reduction) and a high usage of single patient medical folders (i.e., 99%). In conclusion, a defined medical records filing system with adequate training, logistics and regular monitoring and supervision minimises issuance of multiple folders and misfiling.

  20. Community-oriented medical education and clinical training: comparison by medical students in hospitals.

    PubMed

    Ali, Azizi

    2012-10-01

    To determine the students' comparison of their one month educational trainings in Community-Oriented Medical Education with hospitals clinical education. Observational study. Kermanshah Community-Oriented Medical Education Field, Kermanshah University of Medical Sciences, Kermanshah, Iran, from April 2000 to February 2009. As of 2000, medical interns of Kermanshah University of Medical Sciences spend one month in the field of community-oriented medical education. At the end of the one-month period, the interns filled a questionnaire of 11 questions (based on the Likert scale) to assess the level of education in the field compared to hospital clinics. Data of questionnaires collected and completed from 2000 through 2009 (948 questionnaires) were analyzed on SPSS 18 using descriptive statistics (percentage) and analytic statistics (Chi-square test). The 948 students consisted of 66.4% males (n = 666) and 33.6% females (n = 282). All 11 variables of comparison were rated improved in the field education compared to the hospital training. The greatest difference pertained referring patients to the relevant health units (82% vs. 23.3%); patience in education (84.6% vs. 37.1%); consideration given to the three levels of prevention (77.2% vs. 33.6%) and the attention paid to the presence of students (91.7% vs. 51.8%), all of which were statistically significant (p < 0.0001). According to the interns, the educational status of specialized clinics of the field was superior to the specific clinics of hospitals (p < 0.0001). From the standpoint of medical students, training in community-oriented medical education in the field was better than training in the hospitals' clinics.

  1. Potentially high-risk medication categories and unplanned hospitalizations: a case–time–control study

    PubMed Central

    Lin, Chih-Wan; Wen, Yu-Wen; Chen, Liang-Kung; Hsiao, Fei-Yuan

    2017-01-01

    Empirical data of medication-related hospitalization are very limited. We aimed to investigate the associations between 12 high risk medication categories (diabetic agents, diuretics, nonsteroidal anti-inflammatory drugs (NSAIDs), anticoagulants, antiplatelets, antihypertensives, antiarrhythmics, anticonvulsants, antipsychotics, antidepressants, benzodiazepine (BZD)/Z-hypnotics, and narcotics) and unplanned hospitalizations. A population-based case–time–control study was performed using Taiwan’s National Health Insurance Research Database. Patients who experienced an unplanned hospitalization (index visit) were identified as index subjects and matched to a randomly selected reference visit within users of a specific category of high-risk medication. An unplanned hospitalization was defined as a hospital admission immediately after an emergency department visit. Discordant exposures to the high-risk medication during the case period (1–14 days before the visit) and the control period (366–379 days before the visit) were examined in both index and reference visits. Antipsychotics was associated with the highest risk of unplanned hospitalizations (adjusted OR: 1.54, 95% CI [1.37–1.73]), followed by NSAIDs (1.50, [1.44–1.56]), anticonvulsants (1.34, [1.10–1.64]), diuretics (1.24, [1.15–1.33]), BZD/Z-hypnotics (1.23, [1.16–1.31]), antidepressants (1.17, [1.05–1.31]) and antiplatelets (1.16, [1.07–1.26]). NSAIDs and narcotics were associated with the highest risks of unplanned hospitalizations with a length of stay ≥10 days. These medication categories should be targeted for clinical and policy interventions. PMID:28112193

  2. National Hospital Ambulatory Medical Care Survey: 1992 Emergency Department Summary.

    PubMed

    Schappert, S M

    1997-03-01

    This report presents data on the provision and utilization of ambulatory medical care services in hospital emergency departments during 1992. Ambulatory medical care services are described in terms of patient, visit, and facility characteristics. Among these are the patient's reason for the visit, diagnostic and screening services ordered or provided, diagnosis, and medications provided or prescribed. Cause of injury data are presented for injury-related visits. Data presented in this report are from the 1992 National Hospital Ambulatory Medical Care Survey (NHAMCS), a national survey of non-Federal, general and short-stay hospitals, conducted by the Division of Health Care Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention. This report reflects the survey's first year of data collection. A four-stage probability sample design was used, resulting in a sample of 524 non-Federal, general and short-stay hospitals. Ninety-two percent of eligible facilities participated in the survey. Hospital staff were asked to complete Patient Record forms for a systematic random sample of patient visits occurring during a randomly assigned 4-week reporting period, and 36,271 forms were completed by participating emergency departments. Diagnosis and cause of injury were coded according to the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM). Reason for visit and medications were coded according to systems developed by the National Center for Health Statistics. An estimated 89.8 million visits were made to the emergency departments of non-Federal, general and short-stay hospitals in the United States during 1992-357.1 visits per 1,000 persons. Persons 75 years of age and over had a higher visit rate than persons in five other age categories. White persons accounted for 78.5 percent of all visits. However, the visit rate for black persons was significantly higher than for white persons overall and for

  3. Medical conditions associated with out-of-hospital endotracheal intubation.

    PubMed

    Wang, Henry E; Balasubramani, G K; Cook, Lawrence J; Yealy, Donald M; Lave, Judith R

    2011-01-01

    While prior studies describe the clinical presentation of patients requiring paramedic out-of-hospital endotracheal intubation (ETI), limited data characterize the underlying medical conditions or comorbidities. To characterize the medical conditions and comorbidities of patients receiving successful paramedic out-of-hospital ETI. We used Pennsylvania statewide emergency medical services (EMS) clinical data, including all successful ETIs performed during 2003-2005. Using multiple imputation triple-match algorithms, we probabilistically linked EMS ETI to statewide death and hospital admission data. Each hospitalization record contained one primary and up to eight secondary diagnoses, classified according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). We determined the proportion of patients in each major ICD-9-CM diagnostic group and subgroup. We calculated the Charlson Comorbidity Index score for each patient. Using binomial proportions with confidence intervals (CIs), we analyzed the data and combined imputed results using Rubin's method. Across the imputed sets, we linked 25,733 (77.7% linkage) successful ETIs to death or hospital records; 56.3% patients died before and 43.7% survived to hospital admission. Of the 14,478 patients who died before hospital admission, most (92.7%; 95% CI: 92.5-93.3%) had presented to EMS in cardiac arrest. Of the 11,255 hospitalized patents, the leading primary diagnoses were circulatory diseases (32.0%; 95% CI: 30.2-33.7%), respiratory diseases (22.8%; 95% CI: 21.9-23.7%), and injury or poisoning (25.2%; 95% CI: 22.7-27.8%). Prominent primary diagnosis subgroups included asphyxia and respiratory failure (15.2%), traumatic brain injury and skull fractures (11.3%), acute myocardial infarction and ischemic heart disease (10.9%), poisonings and drug and alcohol disorders (6.7%), dysrhythmias (6.7%), hemorrhagic and nonhemorrhagic stroke (5.9%), acute heart failure and cardiomyopathies

  4. Hospital Social Work and Spirituality: Views of Medical Social Workers.

    PubMed

    Pandya, Samta P

    2016-01-01

    This article is based on a study of 1,389 medical social workers in 108 hospitals across 12 countries, on their views on spirituality and spiritually sensitive interventions in hospital settings. Results of the logistic regression analyses and structural equation models showed that medical social workers from European countries, United States of America, Canada, and Australia, those had undergone spiritual training, and those who had higher self-reported spiritual experiences scale scores were more likely to have the view that spirituality in hospital settings is for facilitating integral healing and wellness of patients and were more likely to prefer spiritual packages of New Age movements as the form of spiritual program, understand spiritual assessment as assessing the patients' spiritual starting point, to then build on further interventions and were likely to attest the understanding of spiritual techniques as mindfulness techniques. Finally they were also likely to understand the spiritual goals of intervention in a holistic way, that is, as that of integral healing, growth of consciousness and promoting overall well-being of patients vis-à-vis only coping and coming to terms with health adversities. Results of the structural equation models also showed covariances between religion, spirituality training, and scores on the self-reported spiritual experiences scale, having thus a set of compounding effects on social workers' views on spiritual interventions in hospitals. The implications of the results for health care social work practice and curriculum are discussed.

  5. 78 FR 54766 - Federal Plan Requirements for Hospital/Medical/Infectious Waste Incinerators Constructed On or...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-06

    .../Medical/Infectious Waste Incinerators Constructed On or Before December 1, 2008, and Standards of Performance for New Stationary Sources: Hospital/Medical/Infectious Waste Incinerators Correction In...

  6. Medication dosing errors and associated factors in hospitalized pediatric patients from the South Area of the West Bank - Palestine.

    PubMed

    Al-Ramahi, Rowa'; Hmedat, Bayan; Alnjajrah, Eman; Manasrah, Israa; Radwan, Iqbal; Alkhatib, Maram

    2017-09-01

    Medication dosing errors are a significant global concern and can cause serious medical consequences for patients. Pediatric patients are at increased risk of dosing errors due to differences in medication pharmacodynamics and pharmacokinetics. The aims of this study were to find the rate of medication dosing errors in hospitalized pediatric patients and possible associated factors. The study was an observational cohort study including pediatric inpatients less than 16 years from three governmental hospitals from the West Bank/Palestine during one month in 2014, and sample size was 400 pediatric inpatients from these three hospitals. Pediatric patients' medical records were reviewed. Patients' weight, age, medical conditions, all prescribed medications, their doses and frequency were documented. Then the doses of medications were evaluated. Among 400 patients, the medications prescribed were 949 medications, 213 of them (22.4%) were out of the recommended range, and 160 patients (40.0%) were prescribed one or more potentially inappropriate doses. The most common cause of hospital admission was sepsis which presented 14.3% of cases, followed by fever (13.5%) and meningitis (10.0%). The most commonly used medications were ampicillin in 194 cases (20.4%), ceftriaxone in 182 cases (19.2%), and cefotaxime in 144 cases (12.0%). No significant association was found between potentially inappropriate doses and gender or hospital (chi-square test p-value > 0.05).The results showed that patients with lower body weight, who had a higher number of medications and stayed in hospital for a longer time, were more likely to have inappropriate doses. Potential medication dosing errors were high among pediatric hospitalized patients in Palestine. Younger patients, patients with lower body weight, who were prescribed higher number of medications and stayed in hospital for a longer time were more likely to have inappropriate doses, so these populations require special care. Many

  7. From closet to library in the community hospital: remodeling a hospital medical library.

    PubMed

    Duva, A M

    1971-01-01

    Halifax District Hospital's Medical Library, Daytona Beach, Florida was altered from two dingy rooms to a modern, well-equipped Medical Library twice its former size by its maintenance men in six months time, with the help of the librarian's sketches and an architect student from the junior college to draw the plans.A complete renovation was done, eighteen-inch walls between rooms being demolished, plumbing, ceiling, and windows removed. These were all replaced with walnut-paneled walls, special 125 candle-power lighted ceiling, retractable shelves, more shelves for periodicals and books, wall-to-wall carpeting and fashionable decor. New furniture, tape recorders, and TWX were made possible by a Medical Library Resource Grant. The official opening was six months from the first day of renovation, with ribbon cutting, guests, hospital personnel, and a reporter from the newspaper to take pictures for an article about the most modern medical library in Volusia County. The new Medical Library is in the "core" of the Medical Education Department with space for five years growth.

  8. From Closet to Library in the Community Hospital: Remodeling a Hospital Medical Library

    PubMed Central

    Duva, Alice M.

    1971-01-01

    Halifax District Hospital's Medical Library, Daytona Beach, Florida was altered from two dingy rooms to a modern, well-equipped Medical Library twice its former size by its maintenance men in six months time, with the help of the librarian's sketches and an architect student from the junior college to draw the plans. A complete renovation was done, eighteen-inch walls between rooms being demolished, plumbing, ceiling, and windows removed. These were all replaced with walnut-paneled walls, special 125 candle-power lighted ceiling, retractable shelves, more shelves for periodicals and books, wall-to-wall carpeting and fashionable decor. New furniture, tape recorders, and TWX were made possible by a Medical Library Resource Grant. The official opening was six months from the first day of renovation, with ribbon cutting, guests, hospital personnel, and a reporter from the newspaper to take pictures for an article about the most modern medical library in Volusia County. The new Medical Library is in the “core” of the Medical Education Department with space for five years growth. PMID:5542918

  9. Development of a tool within the electronic medical record to facilitate medication reconciliation after hospital discharge

    PubMed Central

    Liang, Catherine L; Hamann, Claus; Karson, Andrew S; Palchuk, Matvey B; McCarthy, Patricia C; Sherlock, Melanie; Turchin, Alexander; Bates, David W

    2011-01-01

    Serious medication errors occur commonly in the period after hospital discharge. Medication reconciliation in the postdischarge ambulatory setting may be one way to reduce the frequency of these errors. The authors describe the design and implementation of a novel tool built into an ambulatory electronic medical record (EMR) to facilitate postdischarge medication reconciliation. The tool compares the preadmission medication list within the ambulatory EMR to the hospital discharge medication list, highlights all changes, and allows the EMR medication list to be easily updated. As might be expected for a novel tool intended for use in a minority of visits, use of the tool was low at first: 20% of applicable patient visits within 30 days of discharge. Clinician outreach, education, and a pop-up reminder succeeded in increasing use to 41% of applicable visits. Review of feedback identified several usability issues that will inform subsequent versions of the tool and provide generalizable lessons for how best to design medication reconciliation tools for this setting. PMID:21486889

  10. Medical Conditions Associated with Out-of-Hospital Endotracheal Intubation

    PubMed Central

    Wang, Henry E.; Balasubramani, G. K.; Cook, Lawrence J.; Yealy, Donald M.; Lave, Judith R.

    2011-01-01

    OBJECTIVE While prior studies describe the clinical presentation of patients requiring paramedic out-of-hospital endotracheal intubation (ETI), limited data characterize the underlying medical conditions or comorbidities. We sought to characterize the medical conditions and comorbidities of patients receiving successful paramedic out-of-hospital ETI. METHODS We used Pennsylvania statewide EMS clinical data, including all successful ETIs performed during 2003–2005. Using multiple imputation triple-match algorithms, we probabilistically linked EMS ETI to statewide death and hospital admission data. Each hospitalization record contained one primary and up to eight secondary diagnoses, classified according to the International Classification of Diseases, Clinical Modification, ninth edition (ICD-9-CM). We determined the proportion of patients in each major ICD-9-CM diagnostic group and subgroup. We calculated the Charlson Comorbidity Index for each patient. Using binomial proportions with confidence intervals, we analyzed the data and combined imputed results using Rubin's method. RESULTS Across the imputed sets, we linked 25,733 (77.7% linkage) successful ETI to death or hospital records; 56.3% died before and 43.7% survived to hospital admission. Of the 14,479 deaths before hospital admission, most (92.7%, 95% CI: 92.5–93.3%) presented to EMS in cardiac arrest. Of the 11,255 hospitalized patents, the leading primary diagnoses were circulatory diseases (32.0%, 30.2–33.7%), respiratory diseases (22.8%, 21.9–23.7%), and injury or poisoning (25.2%; 22.7–27.8%). Prominent primary diagnosis subgroups included: asphyxia and respiratory failure (15.2%), traumatic brain injury and skull fractures (11.3%), acute myocardial infarction and ischemic heart disease (10.9%), poisoning, drug and alcohol disorders (6.7%), dysrhythmias (6.7%), hemorrhagic and non-hemorrhagic stroke (5.9%), acute heart failure and cardiomyopathies (5.6%), pneumonia and aspiration (4.9%), and

  11. Pharmacist Staffing, Technology Use, and Implementation of Medication Safety Practices in Rural Hospitals

    ERIC Educational Resources Information Center

    Casey, Michelle M.; Moscovice, Ira S.; Davidson, Gestur

    2006-01-01

    Context: Medication safety is clearly an important quality issue for rural hospitals. However, rural hospitals face special challenges implementing medication safety practices in terms of their staffing and financial and technical resources. Purpose: This study assessed the capacity of small rural hospitals to implement medication safety…

  12. Pharmacist Staffing, Technology Use, and Implementation of Medication Safety Practices in Rural Hospitals

    ERIC Educational Resources Information Center

    Casey, Michelle M.; Moscovice, Ira S.; Davidson, Gestur

    2006-01-01

    Context: Medication safety is clearly an important quality issue for rural hospitals. However, rural hospitals face special challenges implementing medication safety practices in terms of their staffing and financial and technical resources. Purpose: This study assessed the capacity of small rural hospitals to implement medication safety…

  13. 78 FR 28051 - Federal Plan Requirements for Hospital/Medical/Infectious Waste Incinerators Constructed On or...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-13

    ... Standards of Performance for New Stationary Sources: Hospital/Medical/Infectious Waste Incinerators; Final... Standards of Performance for New Stationary Sources: Hospital/Medical/Infectious Waste Incinerators AGENCY... federal plan and the new source performance standards for hospital/medical/infectious waste incinerators...

  14. 78 FR 72581 - Direct Final Approval of Hospital/Medical/Infectious Waste Incinerator Negative Declaration for...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-03

    ... AGENCY 40 CFR Part 62 Direct Final Approval of Hospital/Medical/Infectious Waste Incinerator Negative... negative declarations from Michigan and Wisconsin regarding Hospital/Medical/ Infectious Waste Incinerator... combusts any amount of hospital waste and/or medical/infectious waste. The designated facilities to...

  15. Interactive Videodisc Case Studies for Medical Education

    PubMed Central

    Harless, William G.; Zier, Marcia A.; Duncan, Robert C.

    1986-01-01

    The TIME Project of the Lister Hill National Center for Biomedical Communications is using interactive videodisc, microprocessor and voice recognition technology to create patient simulations for use in the training of medical students. These interactive case studies embody dramatic, lifelike portrayals of the social and medical conditions of a patient and allow uncued, verbal intervention by the student for independent clinical decisions.

  16. [The university hospital palliative care team's approach to the transfer of end-stage cancer patients from hospital care to home medical care].

    PubMed

    Yoshino, Kazuho; Nishiumi, Noboru; Kushino, Nobuhisa; Tsukada, Michiko; Douzono, Sachiko; Saito, Yuki; Yagame, Mitsunori; Tokuda, Yutaka

    2009-12-01

    The palliative care team's roles are to provide a symptom relief to cancer patients, help them accept their medical conditions, and offer advice regarding the selection of appropriate medical treatments to suit their needs. Seeking the comfort of their homes, patients prefer a home care of superior medical care provided at hospitals. In 2008, 25 of the end-stage cancer patients at hospitals were expressed their desires to have a home medical care, and 10 of them were allowed to do so. We considered the following contributing factors that a patient should have for a smooth transition from hospital care to home medical care: (1) life expectancy of more than 2 months, (2) no progressive breathing difficulties experienced daily, (3) good awareness of medical condition among patients and families, (4) living with someone who has a good understanding of the condition, (5) availability of an appropriate hospital in case of a sudden change in medical requirements, and (6) good collaboration between emergency care hospitals, home physicians, and visiting nurses. To treat the end-stage cancer patients at home, there is a need for information sharing and a joint training of physicians specialized in cancer therapy, palliative care teams, home physicians, and visiting nurses. This would ensure a sustainable "face-to-face collaboration" in community health care.

  17. Medical Device-Associated Candida Infections in a Rural Tertiary Care Teaching Hospital of India.

    PubMed

    Deorukhkar, Sachin C; Saini, Santosh

    2016-01-01

    Health care associated infections (HCAIs) add incrementally to the morbidity, mortality, and cost expected of the patient's underlying diseases alone. Approximately, about half all cases of HCAIs are associated with medical devices. As Candida medical device-associated infection is highly drug resistant and can lead to serious life-threatening complications, there is a need of continuous surveillance of these infections to initiate preventive and corrective measures. The present study was conducted at a rural tertiary care hospital of India with an aim to evaluate the rate of medical device-associated Candida infections. Three commonly encountered medical device-associated infections (MDAI), catheter-associated urinary tract infection (CA-UTI), intravascular catheter-related blood stream infections (CR-BSI), and ventilator-associated pneumonia (VAP), were targeted. The overall rate of MDAI in our hospital was 2.1 per 1000 device days. The rate of Candida related CA-UTI and CR-BSI was noted as 1.0 and 0.3, respectively. Untiring efforts taken by team members of Hospital Acquired Infection Control Committee along with maintenance of meticulous hygiene of the hospital and wards may explain the low MDAI rates in our institute. The present surveillance helped us for systematic generation of institutional data regarding MDAI with special reference to role of Candida spp.

  18. Development of hospital data warehouse for cost analysis of DPC based on medical costs.

    PubMed

    Muranaga, F; Kumamoto, I; Uto, Y

    2007-01-01

    To develop a data warehouse system for cost analysis, based on the categories of the diagnosis procedure combination (DPC) system, in which medical costs were estimated by DPC category and factors influencing the balance between costs and fees. We developed a data warehouse system for cost analysis using data from the hospital central data warehouse system. The balance data of patients who were discharged from Kagoshima University Hospital from April 2003 to March 2005 were determined in terms of medical procedure, cost per day and patient admission in order to conduct a drill-down analysis. To evaluate this system, we analyzed cash flow by DPC category of patients who were categorized as having malignant tumors and whose DPC category was reevaluated in 2004. The percentages of medical expenses were highest in patients with acute leukemia, non-Hodgkin's lymphoma, and particularly in patients with malignant tumors of the liver and intrahepatic bile duct. Imaging tests degraded the percentages of medical expenses in Kagoshima University Hospital. These results suggested that cost analysis by patient is important for hospital administration in the inclusive evaluation system using a case-mix index such as DPC.

  19. A management plan for hospitals and medical centers facing radiation incidents

    PubMed Central

    Davari, Fereshteh; Zahed, Arash

    2015-01-01

    Background: Nowadays, application of nuclear technology in different industries has largely expanded worldwide. Proportionately, the risk of nuclear incidents and the resulting injuries have, therefore, increased in recent years. Preparedness is an important part of the crisis management cycle; therefore efficient preplanning seems crucial to any crisis management plan. Equipped with facilities and experienced personnel, hospitals naturally engage with the response to disasters. The main purpose of our study was to present a practical management pattern for hospitals and medical centers in case they encounter a nuclear emergency. Materials and Methods: In this descriptive qualitative study, data were collected through experimental observations, sources like Safety manuals released by the International Atomic Energy Agency and interviews with experts to gather their ideas along with Delphi method for polling, and brainstorming. In addition, the 45 experts were interviewed on three targeted using brainstorming and Delphi method. Results: We finally proposed a management plan along with a set of practicality standards for hospitals and medical centers to optimally respond to nuclear medical emergencies when a radiation incident happens nearby. Conclusion: With respect to the great importance of preparedness against nuclear incidents adoption and regular practice of nuclear crisis management codes for hospitals and medical centers seems quite necessary. PMID:26759575

  20. Medical Device-Associated Candida Infections in a Rural Tertiary Care Teaching Hospital of India

    PubMed Central

    Deorukhkar, Sachin C.; Saini, Santosh

    2016-01-01

    Health care associated infections (HCAIs) add incrementally to the morbidity, mortality, and cost expected of the patient's underlying diseases alone. Approximately, about half all cases of HCAIs are associated with medical devices. As Candida medical device-associated infection is highly drug resistant and can lead to serious life-threatening complications, there is a need of continuous surveillance of these infections to initiate preventive and corrective measures. The present study was conducted at a rural tertiary care hospital of India with an aim to evaluate the rate of medical device-associated Candida infections. Three commonly encountered medical device-associated infections (MDAI), catheter-associated urinary tract infection (CA-UTI), intravascular catheter-related blood stream infections (CR-BSI), and ventilator-associated pneumonia (VAP), were targeted. The overall rate of MDAI in our hospital was 2.1 per 1000 device days. The rate of Candida related CA-UTI and CR-BSI was noted as 1.0 and 0.3, respectively. Untiring efforts taken by team members of Hospital Acquired Infection Control Committee along with maintenance of meticulous hygiene of the hospital and wards may explain the low MDAI rates in our institute. The present surveillance helped us for systematic generation of institutional data regarding MDAI with special reference to role of Candida spp. PMID:26904115

  1. A management plan for hospitals and medical centers facing radiation incidents.

    PubMed

    Davari, Fereshteh; Zahed, Arash

    2015-09-01

    Nowadays, application of nuclear technology in different industries has largely expanded worldwide. Proportionately, the risk of nuclear incidents and the resulting injuries have, therefore, increased in recent years. Preparedness is an important part of the crisis management cycle; therefore efficient preplanning seems crucial to any crisis management plan. Equipped with facilities and experienced personnel, hospitals naturally engage with the response to disasters. The main purpose of our study was to present a practical management pattern for hospitals and medical centers in case they encounter a nuclear emergency. In this descriptive qualitative study, data were collected through experimental observations, sources like Safety manuals released by the International Atomic Energy Agency and interviews with experts to gather their ideas along with Delphi method for polling, and brainstorming. In addition, the 45 experts were interviewed on three targeted using brainstorming and Delphi method. We finally proposed a management plan along with a set of practicality standards for hospitals and medical centers to optimally respond to nuclear medical emergencies when a radiation incident happens nearby. With respect to the great importance of preparedness against nuclear incidents adoption and regular practice of nuclear crisis management codes for hospitals and medical centers seems quite necessary.

  2. Consultant input in acute medical admissions and patient outcomes in hospitals in England: a multivariate analysis.

    PubMed

    Bell, Derek; Lambourne, Adrian; Percival, Frances; Laverty, Anthony A; Ward, David K

    2013-01-01

    Recent recommendations for physicians in the UK outline key aspects of care that should improve patient outcomes and experience in acute hospital care. Included in these recommendations are Consultant patterns of work to improve timeliness of clinical review and improve continuity of care. This study used a contemporaneous validated survey compared with clinical outcomes derived from Hospital Episode Statistics, between April 2009 and March 2010 from 91 acute hospital sites in England to evaluate systems of consultant cover for acute medical admissions. Clinical outcomes studied included adjusted case fatality rates (aCFR), including the ratio of weekend to weekday mortality, length of stay and readmission rates. Hospitals that had an admitting Consultant presence within the Acute Medicine Unit (AMU, or equivalent) for a minimum of 4 hours per day (65% of study group) had a lower aCFR compared with hospitals that had Consultant presence for less than 4 hours per day (p<0.01) and also had a lower 28 day re-admission rate (p<0.01). An 'all inclusive' pattern of Consultant working, incorporating all the guideline recommendations and which included the minimum Consultant presence of 4 hours per day (29%) was associated with reduced excess weekend mortality (p<0.05). Hospitals with >40 acute medical admissions per day had a lower aCFR compared to hospitals with fewer than 40 admissions per day (p<0.03) and had a lower 7 day re-admission rate (p<0.02). This study is the first large study to explore the potential relationships between systems of providing acute medical care and clinical outcomes. The results show an association between well-designed systems of Consultant working practices, which promote increased patient contact, and improved patient outcomes in the acute hospital setting.

  3. Targeted temperature management for acute encephalopathy in a Japanese secondary emergency medical care hospital.

    PubMed

    Murata, Shinya; Kashiwagi, Mitsuru; Tanabe, Takuya; Oba, Chizu; Shigehara, Seiji; Yamazaki, Satoshi; Ashida, Atsuko; Sirasu, Akihiko; Inoue, Keisuke; Okasora, Keisuke; Tamai, Hiroshi

    2016-03-01

    The goals of this study, conducted in our secondary emergency care hospital, were to assess the effectiveness of targeted temperature management (TTM) for acute encephalopathy secondary to status epilepticus and to consider appropriate adaptations for use of TTM in this setting. Medical records of patients admitted with acute encephalopathy to Hirakata City Hospital between January 2010 and December 2014 were retrospectively reviewed. Cases treated with TTM (36 °C) and methylprednisolone pulse (MP) therapy (TTM/MP) were compared with those treated with conventional MP regarding clinical courses and outcomes. In total, 20 children were retrospectively enrolled. In the TTM/MP group (10 cases) all survived intact. In the MP group (10 cases), 4 cases were left with neurological sequelae. Furthermore, in the TTM/MP group, the body temperature dropped more quickly. For pediatricians in this secondary emergency hospital, implementing the body temperature management system was not difficult. There were no complications caused by hypothermia. Use of TTM as the initial treatment for acute encephalopathy in the early-onset stage is possible in a secondary emergency care hospital. However, some acute encephalopathy cases are the so-called fulminant type; DIC or shock develops soon after onset and so it is sometimes difficult to introduce TTM. Fulminant-type patients should be transported to tertiary emergency care hospitals. Secondary emergency care hospitals must carefully select cases for TTM, keeping the possibility of transport to a tertiary emergency hospital in mind at all times. Copyright © 2015 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

  4. [Muskuloskeletal disorders in construction industry: hospital cases].

    PubMed

    Santini, M; Riva, M M; Mosconi, G

    2012-01-01

    The authors analyse 493 hospital cases in 356 workers from the construction industry, came to observation for musculoskeletal disorders (average age 48, 2 years, SD 9; work seniority 32, 2 years, SD 9, 7; work seniority in construction industry 27, 3 years, SD 12, 4). The evaluation was required in 305 subjects (85.7% of the sample) to investigate one or more suspected WMDS; in 51 subjects (14.3% of the sample) to express an opinion on fitness to work or residual work capacity. Investigations led to diagnosis of 479 musculoskeletal disorders; the districts most affected are spine and upper limb. 64.7% of the musculoskeletal disorders was evaluated to be work-related, the percentage rises to 68% when considering only cases sent for evaluation of suspected WMDS. The most frequent reasons to exclude relation between the musculoskeletal disorders and work were an high age at diagnosis, presence of comorbidity or outcome of trauma, a disease mismatch exposure.

  5. Hospital solid waste management practices in Limpopo Province, South Africa: A case study of two hospitals

    SciTech Connect

    Nemathaga, Felicia; Maringa, Sally; Chimuka, Luke

    2008-07-01

    The shortcomings in the management practices of hospital solid waste in Limpopo Province of South Africa were studied by looking at two hospitals as case studies. Apart from field surveys, the generated hospital waste was weighed to compute the generation rates and was followed through various management practices to the final disposal. The findings revealed a major policy implementation gap between the national government and the hospitals. While modern practices such as landfill and incineration are used, their daily operations were not carried according to minimum standards. Incinerator ash is openly dumped and wastes are burned on landfills instead of being covered with soil. The incinerators used are also not environmentally friendly as they use old technology. The findings further revealed that there is no proper separation of wastes according to their classification as demanded by the national government. The mean percentage composition of the waste was found in the following decreasing order: general waste (60.74%) > medical waste (30.32%) > sharps (8.94%). The mean generation rates were found to be 0.60 kg per patient per day.

  6. [The early medical textbooks in Korea: medical textbooks published at Je Joong Won-Severance Hospital Medical School].

    PubMed

    Park, H W

    1998-01-01

    Kwang Hye Won(Je Joong Won), the first western hospital in Korea, was founded in 1885. The first western Medical School in Korea was open in 1886 under the hospital management. Dr. O. R. Avison, who came to Korea in 1893, resumed the medical education there, which was interrupted for some time before his arrival in Korea. He inaugurated translating and publishing medical textbooks with the help of Kim Pil Soon who later became one of the first seven graduates in Severance Hospital Medical School. The first western medical textbook translated into Korean was Henry Gray's Anatomy. However, these twice-translated manuscripts were never to be published on account of being lost and burnt down. The existing early anatomy textbooks, the editions of 1906 and 1909, are not the translation of Gray's Anatomy, but that of Japanese anatomy textbook of Gonda. The remaining oldest medical textbook in Korean is Inorganic Materia Medica published in 1905. This book is unique among its kind that O. R. Avison is the only translator of the book and it contains the prefaces of O. R. Avison and Kim Pil Soon. The publication of medical textbook was animated by the participation of other medical students, such as Hong Suk Hoo and Hong Jong Eun. The list of medical textbooks published includes almost all the field of medicine. The medical textbooks in actual existence are as follows: Inorganic Materia Medica (1905), Inorganic Chemistry (1906), Anatomy I (1906), Physiology (1906), Diagnostics I (1906), Diagnostics II (1907), Obstetrics (1908), Organic Chemistry (1909), Anatomy (1909), and Surgery (1910).

  7. Clinical significance of medication reconciliation in children admitted to a UK pediatric hospital: observational study of neurosurgical patients.

    PubMed

    Terry, David R P; Solanki, Guirish A; Sinclair, Anthony G; Marriott, John F; Wilson, Keith A

    2010-10-01

    In December 2007, the National Institute for Health and Clinical Excellence and the National Patient Safety Agency in the UK (NICE-NPSA) published guidance that recommends all adults admitted to hospital receive medication reconciliation, usually by pharmacy staff. A costing and report tool was provided indicating a resource requirement of 12.9 million pounds for England per year. Pediatric patients are excluded from this guidance. To determine the clinical significance of medication reconciliation in children on admission to hospital. A prospective observational study included pediatric patients admitted to a neurosurgical ward at Birmingham Children's Hospital, Birmingham, England, between September 2006 and March 2007. Medication reconciliation was conducted by a pharmacist after the admission of each of 100 consecutive eligible patients aged 4 months to 16 years. The clinical significance of prescribing disparities between pre-admission medications and initial admission medication orders was determined by an expert multidisciplinary panel and quantified using an analog scale. The main outcome measure was the clinical significance of unintentional variations between hospital admission medication orders and physician-prescribed pre-admission medication for repeat (continuing) medications. Initial admission medication orders for children differed from prescribed pre-admission medication in 39% of cases. Half of all resulting prescribing variations in this setting had the potential to cause moderate or severe discomfort or clinical deterioration. These results mirror findings for adults. The introduction of medication reconciliation in children on admission to hospital has the potential to reduce discomfort or clinical deterioration by reducing unintentional changes to repeat prescribed medication. Consequently, there is no justification for the omission of children from the NICE-NPSA guidance concerning medication reconciliation in hospitals, and costing tools

  8. [Extended medical services to the inpatient sector--"medical services on individual demand" in the hospital. General legal conditions, 10 basic rules, and practical examples].

    PubMed

    Kersting, Thomas; Pillokat, Alexander

    2006-01-01

    Today, extended medical services--previously known in the context of ambulant healthcare provision or plastic surgery only--are increasingly being offered by hospitals. Hospitals have started to offer these services with good reason: in times of budgetary restraints they want to exploit this emerging new market due to economic necessities and they try to meet rising demands from patients. It is not easy to draw the line between special (extended) medical services and general hospital services. These different categories need to be kept apart, though. Special contracts for these specific extended medical services have to be entered into by hospital and patient in any case where the hospital wants to charge him later on. Different preconditions are to be considered with patients insured by statutory health insurance companies and privately insured patients. The price of extended medical services must be carefully calculated and, in particular, has to be related to the price charged from patients insured via statutory health insurance. Attention should also be paid to other aspects such as taxes, liability law, and hospital subsidisation. The present article presents some basic rules for offering extra medical services in a hospital.

  9. Medical Clowning and Psychosis: A Case Report and Theoretical Review.

    PubMed

    Gruber, Alex; Levin, Raz; Lichtenberg, Pesach

    2015-01-01

    The medical clown has become an accepted therapeutic figure in non-psychiatric hospital departments in recent years. However, the potential role of the clown in psychiatry, especially for the treatment of psychosis, has not been investigated. We report here on the functioning of a medical clown in an inpatient psychiatric department. A program using psychodramatic group therapy techniques with the clown serving as moderator was developed. We describe the case of one individual diagnosed with schizophrenia who in the course of four and a half months of group therapy led by the medical clown was able to adopt a succession of surprising roles. This process may have contributed to the patient's remission. We discuss the special capacity of medical clowns to encourage communication and indulge in fantasy while returning to consensual reality. We suggest that this may have particular relevance in work with psychotic individuals.

  10. Hospital outpatients' responses to taking medications with driving warnings.

    PubMed

    Smyth, T; Sheehan, M; Siskind, V

    2013-01-01

    The study investigates the knowledge, intentions, and driving behavior of persons prescribed medications that display a warning about driving. It also examines their confidence that they can self-assess possible impairment, as is required by the Australian labeling system. We surveyed 358 outpatients in an Australian public hospital pharmacy, representing a well-advised group taking a range of medications including those displaying a warning label about driving. A brief telephone follow-up survey was conducted with a subgroup of the participants. The sample had a median age of 53.2 years and was 53 percent male. Nearly three quarters (73.2%) had taken a potentially impairing class of medication and more than half (56.1%) had taken more than one such medication in the past 12 months. Knowledge of the potentially impairing effects of medication was relatively high for most items; however, participants underestimated the possibility of increased impairment from exceeding the prescribed dose and at commencing treatment. Participants' responses to the safety implications of taking drugs with the highest level of warning varied. Around two thirds (62.8%) indicated that they would consult a health practitioner for advice and around half would modify their driving in some way. However, one fifth (20.9%) would drive when the traffic was thought to be less heavy and over a third (37.7%) would modify their medication regime so that they could drive. The findings from the follow-up survey of a subsample taking target drugs at the time of the first interview were also of concern. Only just over half (51%) recalled seeing the warning label on their medications and, of this group, three quarters (78%) reported following the warning label advice. These findings indicated that there remains a large proportion of people who either did not notice or did not consider the warning when deciding whether to drive. There was a very high level of confidence in this group that they could

  11. Medical Eschatologies: The Christian Spirit of Hospital Protocol.

    PubMed

    Langford, Jean M

    2016-01-01

    If much has been written of the forms of bodiliness reinforced by hospitals, less attention has been paid to the medicalization of the soul. The medical management of death institutionalizes divisions between body and soul, and matter and spirit, infusing end-of-life care with latent Christian theological presumptions. The invisibility of these presumptions is partly sustained by projecting religiosity on those who endorse other cosmologies, while retaining for medicine a mask of secular science. Stories of conflict with non-Christian patients force these presumptions into visibility, suggesting alternative ethics of care and mourning rooted in other understandings. In this article, I explore one such story. Considering the story as an allegory for how matter and spirit figure in contemporary postmortem disciplines, I suggest that it exposes both the operation of a taboo against mixing material and spiritual agendas, and an assumption that appropriate mourning is oriented toward symbolic homage, rather than concern for the material welfare of the dead.

  12. "On the scene": Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.

    PubMed

    Hoying, Cheryl; Lecher, William T; Mosko, Dee Dee; Roberto, Nancy; Mason, Char; Murphy, Susan Wade; Taylor, Janalee; Cortina, Sandra; Mathison, Elizabeth; Dick, Leaann; Schoettker, Pamela J; Britto, Maria T

    2014-01-01

    Cincinnati Children's Hospital Medical Center is transforming the way it cares for its patients by building a sophisticated model that focuses on accountable care across the continuum. As nurses from different parts of the organization, we act as change agents to develop an integrated structure built around the patient's needs, from prevention to self-management. We demonstrate how organizational structure, fluid staffing, professional practice, and healthy behaviors operationally catalyze the continuum of care, and how we utilize self-management, community-based programs, and care integration to change the outcome for our patients and families. While care coordination is taking on many forms in medical centers around the world, Cincinnati Children's is proud and passionate about sharing its best practices along the way.

  13. Diffusion of Electronic Medical Record Based Public Hospital Information Systems.

    PubMed

    Cho, Kyoung Won; Kim, Seong Min; An, Chang-Ho; Chae, Young Moon

    2015-07-01

    This study was conducted to evaluate the adoption behavior of a newly developed Electronic Medical Record (EMR)-based information system (IS) at three public hospitals in Korea with a focus on doctors and nurses. User satisfaction scores from four performance layers were analyzed before and two times after the newly develop system was introduced to evaluate the adoption process of the IS with Rogers' diffusion theory. The 'intention to use' scores, the most important indicator for determining whether or not to adopt the IS in Rogers' confirmation stage for doctors, were very high in the third survey (4.21). In addition, the scores for 'reduced medication errors', which is the key indicator for evaluating the success of the IS, increased in the third survey for both doctors and nurses. The factors influencing 'intention to use' with a high odds ratio (>1.5) were the 'frequency of attendance of user training sessions', 'mandatory use of system', 'reduced medication errors', and 'reduced medical record documentation time' for both doctors and nurses. These findings show that the new EMR-based IS was well accepted by doctors. Both doctors and nurses also positively considered the effects of the new IS on their clinical environments.

  14. Medication review and transitions of care: a case report of a decade-old medication error.

    PubMed

    Comer, Rachel; Lizer, Mitsi

    2015-03-01

    A 69-year-old Caucasian male with a 25-year history of paranoid schizophrenia was brought to the emergency department because of violence toward the staff in his nursing facility. He was diagnosed with a urinary tract infection and was admitted to the behavioral health unit for medication stabilization. History included a five-year state psychiatric hospital admission and nursing facility placement. Because of poor cognitive function, the patient was unable to corroborate medication history, so the pharmacy student on rotation performed an in-depth chart review. The review revealed a transcription error in 2003 deleting amantadine 100 mg twice daily and adding amiodarone 100 mg twice daily. Subsequent hospitalization resulted in another transcription error increasing the amiodarone to 200 mg twice daily. All electrocardiograms conducted were negative for atrial fibrillation. Once detected, the consulted cardiologist discontinued the amiodarone, and the primary care provider was notified via letter and discharge papers. An admission four months later revealed that the nursing facility restarted the amiodarone. Amiodarone was discontinued and the facility was again notified. This case reviews how a 10-year-old medication error went undetected in the electronic medical records through numerous medication reconciliations, but was uncovered when a single comprehensive medication review was conducted.

  15. [The past and future of surgical clinics of the Mikhailovsky clinical hospital ("Willie Hospital") of the Kirov Military medical academy].

    PubMed

    Samokhvalov, I M; Badalov, V I; Tynyankin, N A; Karev, E A

    2015-07-01

    A brief 140-years history of the Mikhailovsky clinical hospital ("Willie Hospital") of the Kirov Military Medical Academy is presented. Today the department of military surgery, integrated into the system of emergency medical care, locates in historical building of the Kirov Military Medical Academy, and considered as part of multi-field regional center for the treatment of severe combined injuries, and is the only one injury care center of the first level in the Ministry of Defence of the Russian Federation. The hospital admits on treatment more that one million of severe injured patients annually; many patients with severe injuries are transferred from other regional hospitals. Every year more than two thousands of surgical interventions are performed in the hospital. Next renovation of the building is planned in the near future; it should provide further development of new medical technologies in the Kirov Military Medical Academy.

  16. Consumption of herbal remedies and dietary supplements amongst patients hospitalized in medical wards

    PubMed Central

    Goldstein, Lee H; Elias, Mazen; Ron-Avraham, Gilat; Biniaurishvili, Ben Zion; Madjar, Magali; Kamargash, Irena; Braunstein, Rony; Berkovitch, Matitiahu; Golik, Ahuva

    2007-01-01

    What is already known about this subject In general, use of herbal remedies and supplements is constantly rising in the western population and this may be potentially dangerous due to adverse effects and drug–herb interactions. All information up to now has been derived from the general population or outpatients. There are no publications on the rate of consumption of herbals in inpatients, or the awareness of the medical team of this fact. What this study adds Approximately 25% of patients hospitalized in internal medicine wards consume some kind of herbal or dietary supplement.Consumption is associated with higher income, nonsmoking and benign prostatic hypertrophy.The medical team was aware of the consumption in only 23% of the cases, and all drug–herbal interactions which we discovered were missed by the medical team. Aims Herbal remedies may have adverse effects and potentially serious interactions with some commonly prescribed conventional medications. Little is known about consumption of herbal remedies and dietary supplements by hospitalized patients. The aim was to evaluate the rate of consumption and characterize the patients hospitalized in internal medicine departments who consume herbal remedies and dietary supplements. Also, to assess the medical teams' awareness and assess the percentage of patients with possible drug–herb interactions. Methods Patients hospitalized in the medical wards of two hospitals in Israel were interviewed about their use of herbal remedies or dietary supplements. The medical records were searched for evidence that the medical team had knowledge of the use of herbal remedies or dietary supplements. Results Two hundred and ninety-nine hospitalized medical patients were interviewed. Of the participants, 26.8% were herbal or dietary supplement consumers (HC). On multivariate analysis the only variates associated with herbal or dietary supplement consumption were the hospital [odds ratio (OR) 2.97, 95% confidence interval

  17. Reducing hospital noise: a review of medical device alarm management.

    PubMed

    Konkani, Avinash; Oakley, Barbara; Bauld, Thomas J

    2012-01-01

    Increasing noise in hospital environments, especially in intensive care units (ICUs) and operating rooms (ORs), has created a formidable challenge for both patients and hospital staff. A major contributing factor for the increasing noise levels in these environments is the number of false alarms generated by medical devices. This study focuses on discovering best practices for reducing the number of false clinical alarms in order to increase patient safety and provide a quiet environment for both work and healing. The researchers reviewed Pub Med, Web of Knowledge and Google Scholar sources to obtain original journal research and review articles published through January 2012. This review includes 27 critically important journal articles that address different aspects of medical device alarms management, including the audibility, identification, urgency mapping, and response time of nursing staff and different solutions to such problems. With current technology, the easiest and most direct method for reducing false alarms is to individualize alarm settings for each patient's condition. Promoting an institutional culture change that emphasizes the importance of individualization of alarms is therefore an important goal. Future research should also focus on the development of smart alarms.

  18. Psychiatric disorders among elderly patients admitted to hospital medical wards.

    PubMed Central

    Cooper, B

    1987-01-01

    A psychiatric investigation was carried out on patients aged 65-80 years who were admitted to the medical wards of six general hospitals in an industrial urban area of West Germany. In all, 626 patients were screened for cognitive and affective disorder using a short standardized interview, and at the second stage all those with abnormal responses, as well as a subsample of the apparently normal patients, were examined in greater detail. After correction for inaccuracies of screening, the frequency of psychiatric illness in this patient population was estimated as 30.2%, made up of 9.1% with organic brain syndromes and 21.1% with functional mental disorders. Comparison with field-study data for the same background population showed that the hospital patients were at increased risk for mental disturbance. At follow up after one year, outcome in terms of mortality, admission to long-term care and dependency on others was worst for patients with organic mental disorder, even after matching for age and initial severity of physical impairment. Functional mental illness was also associated with a relatively poor outcome in terms of dependency. The mental status of elderly medical patients appears to be important for the prognosis. PMID:3560118

  19. Managing the interface between medical schools, hospitals, and clinical research.

    PubMed

    Gallin, J I; Smits, H L

    1997-02-26

    To review how academic health centers are coping with the changing environment of health care delivery with special emphasis on the impact of the changing health care system on clinical research. In response to Health and Human Services Secretary Donna Shalala's 1995 mandated review of the National Institutes of Health (NIH) Warren Grant Magnuson Clinical Center, an NIH review team visited 30 health facilities and government-owned organizations throughout the country. The review team determined what strategies are used by academic health centers to survive and thrive in the changing health care marketplace. The findings have implications for the NIH Clinical Center as well as academic health centers. Management strategies in successful academic health centers include streamlined governance structures whereby small groups of highly empowered group leaders allow institutions to move quickly and decisively; an active strategic planning process; close integration of hospital and medical school management; heavy investment in information systems; and new structures for patient care delivery. Successful centers are initiating discussions with third-party payers and are implementing new initiatives, such as establishing their own managed care organizations, purchasing physician practices, or owning hospitals. Other approaches include establishing revenue-generating centers for clinical research and new relations with industry. Attention to the infrastructure required to support the training and conduct of clinical research is essential for the future vitality of medical schools.

  20. Evaluation of Unpreparedness When Issuing Copies of Medical Records in Tertiary Referral Hospitals

    PubMed Central

    Moon, Myong-Mo; Seo, Sun-Won; Park, Woo-Sung; Kim, Yoon; Kim, Sung-Soo; Choi, Eun-Mi; Park, Jong; Park, Il-Soon

    2010-01-01

    Objectives As a baseline study to aid in the development of proper policy, we investigated the current condition of unpreparedness of documents required when issuing copies of medical records and related factors. Methods The study was comprised of 7,203 cases in which copies of medical records were issued from July 1st, 2007 through June 30th, 2008 to 5 tertiary referral hospitals. Data from these hospitals was collected using their established electronic databases and included study variables such as unpreparedness of the required documents as a dependent variable and putative covariates. Results The rate of unpreparedness of required documents was 14.9%. Multiple logistic regression analysis revealed the following factors as being related to the high rate of unpreparedness: patient age (older patients had a higher rate), issuance channels (on admission > via out-patient clinic), type of applicant (others such as family members > for oneself > insurers), type of original medical record (utilization records on admission > other records), issuance purpose (for providing insurer > medical use), residential area of applicant (Seoul > Honam province and Jeju), and number of copied documents (more documents gave a lower rate). The rate of unpreparedness differed significantly among the hospitals; suggesting that they may have followed their own conventional protocols rather than legal procedures in some cases. Conclusions The study results showed that the level of compliance to the required legal procedure was high, but that problems occurred in assuring the safety of the medical information. A proper legislative approach is therefore required to balance the security of and access to medical information. PMID:21818431

  1. Hospital-based health technology assessment for innovative medical devices in university hospitals and the role of hospital pharmacists: learning from international experience.

    PubMed

    Martelli, Nicolas; Lelong, Anne-Sophie; Prognon, Patrice; Pineau, Judith

    2013-04-01

    Several models of hospital-based health technology assessment (HTA) have been developed worldwide, for the introduction of innovative medical devices and support evidence-based decision making in hospitals. Two such models, the HTA unit and mini-HTA models, are widespread in university hospitals and involve various stakeholders. The purpose of this work was to highlight the potential role of hospital pharmacists in hospital-based HTA activities. We searched for articles, reviews, and letters relating to hospital-based HTA, as defined by the Hospital-Based Health Technology Assessment Worldwide Survey published by the Health Technology Assessment International (HTAi) Society, in the Health Technology Assessment database, MEDLINE, EMBASE, and hospital pharmacy journals. The number of university hospitals performing hospital-based HTA has increased since the 2008 Hospital-Based Health Technology Assessment Worldwide Survey. Our own experience and international findings show that hospital pharmacists already contribute to hospital-based HTA activities and have developed study interpretation skills and a knowledge of medical devices. Promoting multidisciplinary approaches is one of the key success factors in hospital-based HTA. Hospital pharmacists occupy a position between hospital managers, clinicians, health economists, biomedical engineers, and patients and can provide a new perspective. In the future, hospital pharmacists are likely to become increasingly involved in hospital-based HTA activities.

  2. Brief structured observation of medical student hospital visits.

    PubMed

    Pierce, J Rush; Noronha, Leonard; Collins, N Perryman; Fancovic, Edward

    2013-01-01

    Students' clinical, communication, and professionalism skills are best assessed when faculty directly observe clinical encounters with patients. Prior to 2009, third-year medical students at our institution had one observed clinical encounter by clinic-based faculty during a required internal medicine clerkship. These observations averaged 45 minutes, feedback was not standardized, and student and faculty satisfaction was low. Two hospital-based faculty members redesigned a shorter, standardized exercise during which a faculty member observed the student making rounds on a hospitalized patient that they were actively following. On a checklist, faculty recorded observations about communication (8 items), physical examination (5 items), and professionalism (4 items). Faculty provided immediate feedback. Faculty's direct observation of medical students prerounding on hospitalized internal medicine patients averaged 27 minutes including the feedback to students. In one year, 67/71 (94%) students completed the exercise; records were available for 66 (99%) of these encounters. Time of observation averaged 13.5 minutes (range 3-26 minutes). Feedback averaged 13.4 minutes (range 8-25 minutes). Faculty provided feedback in the following areas (proportion of students): Communication (66/66, 100%); examination skills (63/66, 95%); and professionalism (65/66, 98%). Forty-three students (64%) completed an anonymous satisfaction survey. Thirty-nine of these (91%) found the exercise useful or very useful (average 5-point Likert score = 4.30) and 38 (88%) found it easy or very easy to schedule (average 5-point Likert score = 4.30). Students found this exercise useful and easy to schedule. Faculty consistently provided feedback to students in areas of communication, physical examination, and professionalism.

  3. Medication dispensing errors in a French military hospital pharmacy.

    PubMed

    Bohand, Xavier; Aupée, Olivier; Le Garlantezec, Patrick; Mullot, Hélène; Lefeuvre, Leslie; Simon, Laurent

    2009-08-01

    To determine the rate and the primary types of medication dispensing errors detected by pharmacists during implementation of a unit dose drug dispensing system. The central pharmacy at the Percy French military hospital (France). The check of the unit dose medication cassettes was performed by pharmacists to identify dispensing errors before delivering to the care units. From April 2006 to December 2006, detected errors were corrected and recorded into seven categories: unauthorized drug, wrong dosage-form, improper dose, omission, wrong time, deteriorated drug, and wrong patient errors. Dispensing error rate, calculated by dividing the total of detected errors by the total of filled and omitted doses; classification of recorded dispensing errors. During the study, 9,719 unit dose medication cassettes were filled by pharmacy technicians. Pharmacists detected 706 errors for a total of 88,609 filled and omitted unit doses. An overall error rate of 0.80% was found. There were approximately 0.07 detected dispensing errors per medication cassette. The most common error types were improper dose errors (n = 265, 37.5%) and omission errors (n = 186, 26.3%). Many causes may probably explain the occurrence of dispensing errors, including communication failures, problems related to drug labeling or packaging, distractions, interruptions, heavy workload, and difficulties in reading handwriting prescriptions. The results showed that a wide range of errors occurred during the dispensing process. A check performed after the initial medication selection is also necessary to detect and correct dispensing errors. In order to decrease the occurrence of dispensing errors, some practical measures have been implemented in the central pharmacy. But because some dispensing errors may remain undetected, there is a requirement to develop other strategies that reduce or eliminate these errors. The pharmacy staff is widely involved in this duty.

  4. High-alert medications in a French paediatric university hospital.

    PubMed

    Bataille, Julie; Prot-Labarthe, Sonia; Bourdon, Olivier; Joret, Perrine; Brion, Françoise; Hartmann, Jean-François

    2015-04-01

    High-alert medications (HAMs) are medications that are associated with a high risk of serious harm if used improperly. The objective of this study was to identify paediatric HAM used in our institution and to identify safety measures for their use. The list of HAM and the list of safety measures that were introduced in our department were based on (1) a literature search; (2) a survey of health care professionals in our department including doctors, head nurses, nurses and pharmacists; and (3) the drug steering committee. We found four lists of HAM based on a literature search, including 27 classes of pharmaceutical agents, and 63 common drug names. The response rate of the survey was 20.7% (230 of 1113). Some of the HAMs included in our list were not identified by the literature search. These included neuroleptic drugs, anti-malarial agents, antiviral agents, anti-retroviral agents and intravenous acetaminophen. The drug steering committee selected 17 HAM and highlighted 53 safety measures involving seven broad aspects of pharmacological management. This project was part of the new safety strategies developed in a paediatric hospital. We set out to make a list of HAM relevant to paediatrics with additional safety measures to prevent medication errors associated and a 'joker' system. The various safety measures, such as double-checking of HAM prescriptions, should be reviewed during the year following their implementation. This list, which was developed in our hospital specifically for use in paediatrics, can be adapted for use in other paediatric departments. © 2014 John Wiley & Sons, Ltd.

  5. The Role of Hospital Inpatients in Supporting Medication Safety: A Qualitative Study

    PubMed Central

    Garfield, Sara; Jheeta, Seetal; Husson, Fran; Lloyd, Jill; Taylor, Alex; Boucher, Charles; Jacklin, Ann; Bischler, Anna; Norton, Christine; Hayles, Rob; Dean Franklin, Bryony

    2016-01-01

    Background Inpatient medication errors are a significant concern. An approach not yet widely studied is to facilitate greater involvement of inpatients with their medication. At the same time, electronic prescribing is becoming increasingly prevalent in the hospital setting. In this study we aimed to explore hospital inpatients’ involvement with medication safety-related behaviours, facilitators and barriers to this involvement, and the impact of electronic prescribing. Methods We conducted ethnographic observations and interviews in two UK hospital organisations, one with established electronic prescribing and one that changed from paper to electronic prescribing during our study. Researchers and lay volunteers observed nurses’ medication administration rounds, pharmacists’ ward rounds, doctor-led ward rounds and drug history taking. We also conducted interviews with healthcare professionals, patients and carers. Interviews were audio-recorded and transcribed. Observation notes and transcripts were coded thematically. Results Paper or electronic medication records were shown to patients in only 4 (2%) of 247 cases. However, where they were available during patient-healthcare professional interactions, healthcare professionals often viewed them in order to inform patients about their medicines and answer any questions. Interprofessional discussions about medicines seemed more likely to happen in front of the patient where paper or electronic drug charts were available near the bedside. Patients and carers had more access to paper-based drug charts than electronic equivalents. However, interviews and observations suggest there are potentially more significant factors that affect patient involvement with their inpatient medication. These include patient and healthcare professional beliefs concerning patient involvement, the way in which healthcare professionals operate as a team, and the underlying culture. Conclusion Patients appear to have more access to

  6. The Role of Hospital Inpatients in Supporting Medication Safety: A Qualitative Study.

    PubMed

    Garfield, Sara; Jheeta, Seetal; Husson, Fran; Lloyd, Jill; Taylor, Alex; Boucher, Charles; Jacklin, Ann; Bischler, Anna; Norton, Christine; Hayles, Rob; Franklin, Bryony Dean

    2016-01-01

    Inpatient medication errors are a significant concern. An approach not yet widely studied is to facilitate greater involvement of inpatients with their medication. At the same time, electronic prescribing is becoming increasingly prevalent in the hospital setting. In this study we aimed to explore hospital inpatients' involvement with medication safety-related behaviours, facilitators and barriers to this involvement, and the impact of electronic prescribing. We conducted ethnographic observations and interviews in two UK hospital organisations, one with established electronic prescribing and one that changed from paper to electronic prescribing during our study. Researchers and lay volunteers observed nurses' medication administration rounds, pharmacists' ward rounds, doctor-led ward rounds and drug history taking. We also conducted interviews with healthcare professionals, patients and carers. Interviews were audio-recorded and transcribed. Observation notes and transcripts were coded thematically. Paper or electronic medication records were shown to patients in only 4 (2%) of 247 cases. However, where they were available during patient-healthcare professional interactions, healthcare professionals often viewed them in order to inform patients about their medicines and answer any questions. Interprofessional discussions about medicines seemed more likely to happen in front of the patient where paper or electronic drug charts were available near the bedside. Patients and carers had more access to paper-based drug charts than electronic equivalents. However, interviews and observations suggest there are potentially more significant factors that affect patient involvement with their inpatient medication. These include patient and healthcare professional beliefs concerning patient involvement, the way in which healthcare professionals operate as a team, and the underlying culture. Patients appear to have more access to paper-based records than electronic equivalents

  7. New journals for publishing medical case reports.

    PubMed

    Akers, Katherine G

    2016-04-01

    Because they do not rank highly in the hierarchy of evidence and are not frequently cited, case reports describing the clinical circumstances of single patients are seldom published by medical journals. However, many clinicians argue that case reports have significant educational value, advance medical knowledge, and complement evidence-based medicine. Over the last several years, a vast number (∼160) of new peer-reviewed journals have emerged that focus on publishing case reports. These journals are typically open access and have relatively high acceptance rates. However, approximately half of the publishers of case reports journals engage in questionable or "predatory" publishing practices. Authors of case reports may benefit from greater awareness of these new publication venues as well as an ability to discriminate between reputable and non-reputable journal publishers.

  8. New journals for publishing medical case reports

    PubMed Central

    Akers, Katherine G.

    2016-01-01

    Because they do not rank highly in the hierarchy of evidence and are not frequently cited, case reports describing the clinical circumstances of single patients are seldom published by medical journals. However, many clinicians argue that case reports have significant educational value, advance medical knowledge, and complement evidence-based medicine. Over the last several years, a vast number (∼160) of new peer-reviewed journals have emerged that focus on publishing case reports. These journals are typically open access and have relatively high acceptance rates. However, approximately half of the publishers of case reports journals engage in questionable or “predatory” publishing practices. Authors of case reports may benefit from greater awareness of these new publication venues as well as an ability to discriminate between reputable and non-reputable journal publishers. PMID:27076803

  9. [Clinical features in fatal Spanish influenza: Japanese Army Hospital medical records investigation].

    PubMed

    Fujikura, Yuji; Kawana, Akihiko; Kato, Yasuyuki; Mizuno, Yasutaka; Kudo, Koichiro

    2010-03-01

    Pandemic influenza preparedness requires a thorough knowledge of past pandemics. Tokyo First Army Hospital medical records from January 1918 to December 1920 found recently included 132 consecutive records of those diagnosed with influenza. We report on the clinical features in 8 fatal cases. Inpatient mortality was found to be 6.1% (8/132). Cough was noted in 6 (75%) and thoracic rales in 8 (100%) on admission, mimicking pneumonia. Bloody sputum was noted in 5 (62.5%) and diarrhea in 4 (50%), with marked hemorrhagic and digestive symptoms, resembling highly pathogenic avian influenza. Clinical features may differ from seasonal influenza, making early detection and treatment essential especially in severe cases.

  10. [Management of emergency cases, hospitalized in Romania in 2007].

    PubMed

    Tarcea, Monica; Zugravu, Corina; Szavuj, J; Finta, Hajnal; Patraulea, F; Szasz, F

    2009-01-01

    We evaluated the main aspects of the management of emergency cases, hospitalized in Romania in 2007, by following the frequency of main diagnosis, their distribution by place and hospital and hospital indicators. We collected our data from the Insurance Houses and National Institute of Statistics. Emergency cases represented in 2007 half of total cases hospitalized in Romania. Women are more frequent hospitalized then man or children. The Romanian South-East area had the highest frequency of emergency cases hospitalized. From all types of deceased cases, the emergency cases had the highest frequency. In emergency, the main category of diagnosis by frequency is "pregnancy, birth and recently given birth", much higher than non-emergency cases registered, also at the Obstretics-Gynecology and Emergency Hospitals. The medium period of days hospitalized for emergency cases was one week time. Most of the emergency cases are healed comparing to non-emergency ones. The main problem of hospitals in Romania is related to health services financing, costs for health care are still growing but also did the quality of health services and number of cases coming in emergency rooms.

  11. Factor structure of the SOCRATES questionnaire in hospitalized medical patients

    PubMed Central

    Bertholet, Nicolas; Dukes, Kim; Horton, Nicholas J.; Palfai, Tibor P.; Pedley, Alison; Saitz, Richard

    2009-01-01

    The Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES), a 19-item instrument developed to assess readiness to change alcohol use among individuals presenting for specialized alcohol treatment, has been used in various populations and settings. Its factor structure and concurrent validity has been described for specialized alcohol treatment settings and primary care. The purpose of this study was to determine the factor structure and concurrent validity of the SOCRATES among medical inpatients with unhealthy alcohol use not seeking help for specialized alcohol treatment. The subjects were 337 medical inpatients with unhealthy alcohol use, identified during their hospital stay. Most of them had alcohol dependence (76%). We performed an Alpha Factor Analysis (AFA) and Principal Component Analysis (PCA) of the 19 SOCRATES items, and forced 3 factors and 2 components, in order to replicate findings from Miller & Tonigan (1996) and Maisto et al (1999). Our analysis supported the view that the 2 component solution proposed by Maisto et al (1999) is more appropriate for our data than the 3 factor solution proposed by Miller & Tonigan (1996). The first component measured Perception of Problems and was more strongly correlated with severity of alcohol related consequences, presence of alcohol dependence, and alcohol consumption levels (average number of drinks per day and total number of binge drinking days over the past 30 days)compared to the second component measuring Taking Action. Our findings support the view that the SOCRATES is comprised of two important readiness constructs in general medical patients identified by screening PMID:19395177

  12. Retrospective analysis of 10 year medical board proceedings at Amanuel Hospital Addis Ababa, Ethiopia, 2001.

    PubMed

    Fekadu, Daniel; Alem, Atalay

    2004-01-01

    The Medical board at Amanuel Psychiatric Hospital assesses mental disability. Analysis of the board's proceedings from 1985--1994 is discussed in this paper. The proceeding record showed that the board has assessed 1963 during the ten-year period, but analysis was done only on 1854 cases because of incomplete information. Over 80 % of the cases assessed by the board were males and 96% were below the age of 50 years. Teachers were presented to the board more often than other occupational groups. Over 50% of the cases presented to the board had psychotic illness and 12% had no mental illness. There was a decline in the number of cases presented to the board in the later part of the ten year period (Chi-square for trend=206.36, P<001). Request for assessment of fitness accounted for 79% of all requests presented to the board. Positive recommendation to the request was given to 66% of the cases and transfer from one working place to another was the most frequently given recommendation. It appears that assessment of disability used to be one of the major activities of the psychiatrists at Amanuel Hospital. Creating conducive working environment to the employees, putting some effort to change the attitude of employers toward the mentally disturbed worker and training health workers working in the clinics of enterprises/organizations on basic counseling principles are recommmended to minimize the flow of cases to Amanuel Hospital for this purpose.

  13. Medical leaders or masters?—A systematic review of medical leadership in hospital settings

    PubMed Central

    Fabbricotti, Isabelle N.; Buljac-Samardžić, Martina; Hilders, Carina G. J. M.

    2017-01-01

    Medical leadership is increasingly considered as crucial for improving the quality of care and the sustainability of healthcare. However, conceptual clarity is lacking in the literature and in practice. Therefore, a systematic review of the scientific literature was conducted to reveal the different conceptualizations of medical leadership in terms of definitions, roles and activities, and personal–and context-specific features. Eight databases were systematically searched for eligible studies, including empirical studies published in peer-reviewed journals that included physicians carrying out a manager or leadership role in a hospital setting. Finally, 34 articles were included and their findings were synthesized and analyzed narratively. Medical leadership is conceptualized in literature either as physicians with formal managerial roles or physicians who act as informal ‘leaders’ in daily practices. In both forms, medical leaders must carry out general management and leadership activities and acts to balance between management and medicine, because these physicians must accomplish both organizational and medical staff objectives. To perform effectively, credibility among medical peers appeared to be the most important factor, followed by a scattered list of fields of knowledge, skills and attitudes. Competing logics, role ambiguity and a lack of time and support were perceived as barriers. However, the extent to which physicians must master all elicited features, remains ambiguous. Furthermore, the extent to which medical leadership entails a shift or a reallocation of tasks that are at the core of medical professional work remains unclear. Future studies should implement stronger research designs in which more theory is used to study the effect of medical leadership on professional work, medical staff governance, and subsequently, the quality and efficiency of care. PMID:28910335

  14. Medical leaders or masters?-A systematic review of medical leadership in hospital settings.

    PubMed

    Berghout, Mathilde A; Fabbricotti, Isabelle N; Buljac-Samardžić, Martina; Hilders, Carina G J M

    2017-01-01

    Medical leadership is increasingly considered as crucial for improving the quality of care and the sustainability of healthcare. However, conceptual clarity is lacking in the literature and in practice. Therefore, a systematic review of the scientific literature was conducted to reveal the different conceptualizations of medical leadership in terms of definitions, roles and activities, and personal-and context-specific features. Eight databases were systematically searched for eligible studies, including empirical studies published in peer-reviewed journals that included physicians carrying out a manager or leadership role in a hospital setting. Finally, 34 articles were included and their findings were synthesized and analyzed narratively. Medical leadership is conceptualized in literature either as physicians with formal managerial roles or physicians who act as informal 'leaders' in daily practices. In both forms, medical leaders must carry out general management and leadership activities and acts to balance between management and medicine, because these physicians must accomplish both organizational and medical staff objectives. To perform effectively, credibility among medical peers appeared to be the most important factor, followed by a scattered list of fields of knowledge, skills and attitudes. Competing logics, role ambiguity and a lack of time and support were perceived as barriers. However, the extent to which physicians must master all elicited features, remains ambiguous. Furthermore, the extent to which medical leadership entails a shift or a reallocation of tasks that are at the core of medical professional work remains unclear. Future studies should implement stronger research designs in which more theory is used to study the effect of medical leadership on professional work, medical staff governance, and subsequently, the quality and efficiency of care.

  15. 48 CFR 831.7001-4 - Medical services and hospital care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... hospital care. 831.7001-4 Section 831.7001-4 Federal Acquisition Regulations System DEPARTMENT OF VETERANS... and Procedures 831.7001-4 Medical services and hospital care. (a) VA may pay the customary student... Government. (b) When the customary student's health fee does not cover medical services or hospital care, but...

  16. 48 CFR 831.7001-4 - Medical services and hospital care.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... hospital care. 831.7001-4 Section 831.7001-4 Federal Acquisition Regulations System DEPARTMENT OF VETERANS... and Procedures 831.7001-4 Medical services and hospital care. (a) VA may pay the customary student... Government. (b) When the customary student's health fee does not cover medical services or hospital care, but...

  17. 48 CFR 831.7001-4 - Medical services and hospital care.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... hospital care. 831.7001-4 Section 831.7001-4 Federal Acquisition Regulations System DEPARTMENT OF VETERANS... and Procedures 831.7001-4 Medical services and hospital care. (a) VA may pay the customary student... Government. (b) When the customary student's health fee does not cover medical services or hospital care, but...

  18. 48 CFR 831.7001-4 - Medical services and hospital care.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... hospital care. 831.7001-4 Section 831.7001-4 Federal Acquisition Regulations System DEPARTMENT OF VETERANS... and Procedures 831.7001-4 Medical services and hospital care. (a) VA may pay the customary student... Government. (b) When the customary student's health fee does not cover medical services or hospital care, but...

  19. 48 CFR 831.7001-4 - Medical services and hospital care.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... hospital care. 831.7001-4 Section 831.7001-4 Federal Acquisition Regulations System DEPARTMENT OF VETERANS... and Procedures 831.7001-4 Medical services and hospital care. (a) VA may pay the customary student... Government. (b) When the customary student's health fee does not cover medical services or hospital care, but...

  20. 14 CFR 135.271 - Helicopter hospital emergency medical evacuation service (HEMES).

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ....271 Helicopter hospital emergency medical evacuation service (HEMES). (a) No certificate holder may... assignment, for hospital emergency medical evacuation service helicopter operations unless that assignment... 14 Aeronautics and Space 3 2013-01-01 2013-01-01 false Helicopter hospital emergency...

  1. 14 CFR 135.271 - Helicopter hospital emergency medical evacuation service (HEMES).

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ....271 Helicopter hospital emergency medical evacuation service (HEMES). (a) No certificate holder may... assignment, for hospital emergency medical evacuation service helicopter operations unless that assignment... 14 Aeronautics and Space 3 2012-01-01 2012-01-01 false Helicopter hospital emergency...

  2. 14 CFR 135.271 - Helicopter hospital emergency medical evacuation service (HEMES).

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ....271 Helicopter hospital emergency medical evacuation service (HEMES). (a) No certificate holder may... assignment, for hospital emergency medical evacuation service helicopter operations unless that assignment... 14 Aeronautics and Space 3 2011-01-01 2011-01-01 false Helicopter hospital emergency...

  3. 14 CFR 135.271 - Helicopter hospital emergency medical evacuation service (HEMES).

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ....271 Helicopter hospital emergency medical evacuation service (HEMES). (a) No certificate holder may... assignment, for hospital emergency medical evacuation service helicopter operations unless that assignment... 14 Aeronautics and Space 3 2014-01-01 2014-01-01 false Helicopter hospital emergency...

  4. 14 CFR 135.271 - Helicopter hospital emergency medical evacuation service (HEMES).

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ....271 Helicopter hospital emergency medical evacuation service (HEMES). (a) No certificate holder may... assignment, for hospital emergency medical evacuation service helicopter operations unless that assignment... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Helicopter hospital emergency...

  5. Hospital adoption of medical technology: an empirical test of alternative models.

    PubMed Central

    Teplensky, J. D.; Pauly, M. V.; Kimberly, J. R.; Hillman, A. L.; Schwartz, J. S.

    1995-01-01

    OBJECTIVE. This study examines hospital motivations to acquire new medical technology, an issue of considerable policy relevance: in this case, whether, when, and why hospitals acquire a new capital-intensive medical technology, magnetic resonance imaging equipment (MRI). STUDY DESIGN. We review three common explanations for medical technology adoption: profit maximization, technological preeminence, and clinical excellence, and incorporate them into a composite model, controlling for regulatory differences, market structures, and organizational characteristics. All four models are then tested using Cox regressions. DATA SOURCES. The study is based on an initial sample of 637 hospitals in the continental United States that owned or leased an MRI unit as of 31 December 1988, plus nonadopters. Due to missing data the final sample consisted of 507 hospitals. The data, drawn from two telephone surveys, are supplemented by the AHA Survey, census data, and industry and academic sources. PRINCIPAL FINDING. Statistically, the three individual models account for roughly comparable amounts of variance in past adoption behavior. On the basis of explanatory power and parsimony, however, the technology model is "best." Although the composite model is statistically better than any of the individual models, it does not add much more explanatory power adjusting for the number of variables added. CONCLUSIONS. The composite model identified the importance a hospital attached to being a technological leader, its clinical requirements, and the change in revenues it associated with the adoption of MRI as the major determinants of adoption behavior. We conclude that a hospital's adoption behavior is strongly linked to its strategic orientation. PMID:7649751

  6. Using rhetorical theory in medical ethics cases.

    PubMed

    Heifferon, B

    2000-01-01

    In this paper I argue that rhetorical theory is a valuable tool in medical ethics cases. The case I use as an example is one in which traditional, philosophy-based medical ethics are applied. In this case the traditional ethical approach is not adequate to the task. Key issues and problems are not addressed, resulting in a problem that seems to be solved on the surface, but, when rhetorically analyzed, it's obvious that none of the issues have been resolved in any satisfactory way. By using rhetorical theory, such as that Michel Foucault uses in Power/Knowledge, we discover that the reason this case has not been solved is that the power issues have not been addressed. Using Foucault's concepts of "subjugated knowledge", "local knowledge", "situated knowledge", and "docile bodies", we can tease out the real issues that surface in this ethics case and solve them. Foucault also recommends we use theory as a "toolkit". I propose a model that is a further iteration of this idea. My model uses numerous rhetorical and literary theories, depending on the issues that need to be addressed in each individual medical ethics case. I briefly describe the various theories and include a handout of what the new model of using rhetorical theory in such cases would look like.

  7. Management evaluation about introduction of electric medical record in the national hospital organization.

    PubMed

    Nakagawa, Yoshiaki; Tomita, Naoko; Irisa, Kaoru; Yoshihara, Hiroyuki; Nakagawa, Yoshinobu

    2013-01-01

    Introduction of Electronic Medical Record (EMR) into a hospital was started from 1999 in Japan. Then, most of all EMR company said that EMR improved efficacy of the management of the hospital. National Hospital Organization (NHO) has been promoting the project and introduced EMR since 2004. NHO has 143 hospitals, 51 hospitals offer acute-phase medical care services, the other 92 hospitals offer medical services mainly for chronic patients. We conducted three kinds of investigations, questionnaire survey, checking the homepage information of the hospitals and analyzing the financial statements of each NHO hospital. In this financial analysis, we applied new indicators which have been developed based on personnel costs. In 2011, there are 44 hospitals which have introduced EMR. In our result, the hospital with EMR performed more investment of equipment/capital than personnel expenses. So, there is no advantage of EMR on the financial efficacy.

  8. Influence of computerised medication charts on medication errors in a hospital.

    PubMed

    van Gijssel-Wiersma, Dieuwke G; van den Bemt, Patricia M L A; Walenbergh-van Veen, Monique C M

    2005-01-01

    In hospitals where computerised physician order entry systems will not be available in the near future, there is a need to explore other ways of reducing medication errors that occur in the drug ordering and delivery system. One of these ways is the use of a computerised medication chart that is updated daily. The aim of this study was to evaluate the frequency, types and potential clinical significance of drug prescription and administration errors by comparing a traditional medication distribution system (where the transcription of handwritten into printed medication orders takes 3-5 days and the transfer of medication orders was not complete) with the use of a computerised medication chart (which was updated daily by pharmacy assistants on the ward). Data were collected during two 3-week periods, from a 32-bed internal medicine unit, before and after the introduction of the computerised medication charts. Prescribing errors were observed by evaluation of all new and changed medication orders and administration errors were detected by using the disguised-observation technique. For prescribing errors, a total of 611 prescriptions before and 598 prescriptions after the intervention were evaluated. The total prescription error rate (of medication orders with >or=1 error) was found to be significantly higher with the computerised charts when compared with the old system (50.0% [299 of 598] vs 20.3% [124 of 611], odds ratio [OR] 3.80 [95% CI 2.94, 4.90]). This increase was caused by an increase in administrative prescription errors with a low potential clinical significance (mainly omission of the prescriber's name and the prescription date). The error rate for errors with a potential clinical significance was found to be significantly lower because the prescription error 'duplicate therapy' was eliminated (3.4% with the traditional medication chart vs 0% with the computerised chart). For administration errors, a total of 1122 drugs before the intervention and 1175

  9. [Tracing the map of medication errors outside the hospital environment in the Madrid Community].

    PubMed

    Taravilla-Cerdán, Belén; Larrubia-Muñoz, Olga; de la Corte-García, María; Cruz-Martos, Encarnación

    2011-12-01

    Preparation of a map of medication errors reported by health professionals outside hospitals within the framework of Medication Errors Reporting for the Community of Madrid during the period 2008-2009. Retrospective observational study. Notification database of medication errors in the Community of Madrid. Notifications sent to the web page: Safe Use of Medicines and Health Products of the Community of Madrid. Information on the originator of the report, date of incident, shift, type of error and causes, outcome, patient characteristics, stage, place where it was produced and detected, if the medication was administered, lot number, expiry date and the general nature of the drug and a brief description of the incident. There were 5470 medication errors analysed, of which 3412 came from outside hospitals (62%), occurring mainly in the prescription stage (56.92%) and being more reported pharmacists. No harm was done in 92.9% of cases, but there was harm in 4.8% and in 2.3% there was an error that could not be followed up. The centralization of information has led to the confirmation that the prescription is a vulnerable point in the chain of drug therapy. Cleaning up prescription databases, preventing the marketing of commercial presentations that give rise to confusion, enhanced information to professionals and patients, and establishing standardised procedures, and avoiding the use of ambiguous prescriptions, illegible, or abbreviations, are useful strategies to try to minimise these errors. Copyright © 2010 Elsevier España, S.L. All rights reserved.

  10. An analysis of surgical cases in a Nigerian mission hospital.

    PubMed

    WARD, R V

    1963-08-24

    Approximately 315 major surgical cases were treated in one year in a one-doctor 80-bed mission hospital in Nigeria. The hospital serves a population of 137,000. One hundred and forty-three of the cases were herniorrhaphies: 19 of these cases were strangulated, of which seven required bowel resection. A case of a strangulated inguinal hernia containing uterus, Fallopian tubes and ovaries is reported. Other interesting surgical cases are also discussed.

  11. Scoping medical tourism and international hospital accreditation growth.

    PubMed

    Woodhead, Anthony

    2013-01-01

    Uwe Reinhardt stated that medical tourism can do to the US healthcare system what the Japanese automotive industry did to American carmakers after Japanese products developed a value for money and reliability reputation. Unlike cars, however, healthcare can seldom be test-driven. Quality is difficult to assess after an intervention (posteriori), therefore, it is frequently evaluated via accreditation before an intervention (a priori). This article aims to scope the growth in international accreditation and its relationship to medical tourism markets. Using self-reported data from Accreditation Canada, Joint Commission International (JCI) and Australian Council on Healthcare Standards (ACHS), this article examines how quickly international accreditation is increasing, where it is occurring and what providers have been accredited. Since January 2000, over 350 international hospitals have been accredited; the JCI's total nearly tripling between 2007-2011. Joint Commission International staff have conducted most international accreditation (over 90 per cent). Analysing which countries and regions where the most international accreditation has occurred indicates where the most active medical tourism markets are. However, providers will not solely be providing care for medical tourists. Accreditation will not mean that mistakes will never happen, but that accredited providers are more willing to learn from them, to varying degrees. If a provider has been accredited by a large international accreditor then patients should gain some reassurance that the care they receive is likely to be a good standard. The author questions whether commercializing international accreditation will improve quality, arguing that research is necessary to assess the accreditation of these growing markets.

  12. [Medication dispensing errors detected in medication cassettes intended for in-hospital patients].

    PubMed

    Bohand, X; Grippi, R; Lefeuvre, L; Le Garlantezec, P; Aupée, O; Simon, L

    2008-09-01

    Many dispensing errors occur in hospital pharmacies and can harm patients if they are not intercepted. The aim of this study was to determine the incidence and the primary types of medication dispensing errors at a French military hospital. The check of unit dose medication cassettes was performed by nurses. From February 2007 to April 2007, detected dispensing errors were systematically recorded and classified into 6 categories: unauthorized drug, wrong dosage-form, improper dose, omission, wrong time, and deteriorated drug errors. The overall error rate was calculated. During the study, 5112 medication cassettes were checked. 106 dispensing errors have been detected by nurses for a total of 45,573 filled (n=45,518) and omitted (n=55) unit doses. An overall error rate of 0.23% was found. There were approximately 0.02 detected dispensing errors per medication cassette. The most common error types were omission errors (n=55, 51.88%) and improper dose errors (n=30, 28.30%). The results of this study showed that a check performed by nurses after the dispensing process is necessary to detect the dispensing errors. Many causes may explain the occurrence of dispensing errors and must be corrected. Because some dispensing errors may remain undetected, there is a requirement to develop strategies in order to reduce or eliminate these errors, such as the implementation of a computerized prescribing system. The pharmacy staff is widely involved in this duty.

  13. 38 CFR 17.35 - Hospital care and medical services in foreign countries.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2014-07-01 2014-07-01 false Hospital care and medical services in foreign countries. 17.35 Section 17.35 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital Or Nursing Home Care and Medical Services in Foreign Countries § 17.35...

  14. 38 CFR 17.35 - Hospital care and medical services in foreign countries.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2012-07-01 2012-07-01 false Hospital care and medical services in foreign countries. 17.35 Section 17.35 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital Or Nursing Home Care and Medical Services in Foreign Countries § 17.35...

  15. 38 CFR 17.35 - Hospital care and medical services in foreign countries.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2013-07-01 2013-07-01 false Hospital care and medical services in foreign countries. 17.35 Section 17.35 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital Or Nursing Home Care and Medical Services in Foreign Countries § 17.35...

  16. 38 CFR 17.35 - Hospital care and medical services in foreign countries.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Hospital care and medical services in foreign countries. 17.35 Section 17.35 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital Or Nursing Home Care and Medical Services in Foreign Countries § 17.35...

  17. 38 CFR 17.35 - Hospital care and medical services in foreign countries.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Hospital care and medical services in foreign countries. 17.35 Section 17.35 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital Or Nursing Home Care and Medical Services in Foreign Countries § 17.35...

  18. [HIV antibody detection results in patients seeking medical care in Peking Union Medical College Hospital, 2003-2014].

    PubMed

    Song, X J; Qiu, Z F; Cao, W; Xie, J; Zhang, Z J; Xu, S X; Li, T S

    2017-01-10

    Objective: To better understand the infection status of HIV in the patients seeking medical care in Peking Union Medical College Hospital. Methods: The HIV detection data of the patients in the hospital from 2003-2014 were collected for a statistical analysis with software SPSS 19.0. Results: A total of 715 421 patients were screened, and 1 012 (0.14%) patients were HIV positive, and HIV infection were confirmed in 776 (0.11%) patients by Western Blot testing. The detection rate of HIV infection increased from 0.05% in 2003 to 0.17% in 2014 (trend χ(2)=66.83 , P=0.000), and the increase during 2012-2014 was obvious. Of the 776 newly diagnosed HIV-infected individuals, 631 (81.31%) were men and 145 (18.69%) were women. The percentage of the males infected with HIV increased from 50.00% to 90.26% (trend χ(2)=58.41, P=0.000). The median age was 36 years (interquartile range: 27-43), and the age group 18-50 years were mostly affected. In the 776 patients infected with HIV, 634 (81.70% ) were infected through sexual contacts, and the proportion of sexual transmissions increased with year (trend χ(2)=126.38, P=0.000). The proportion of infected men who have sex with men (MSM) increased from 0% in 2003 to 53.90% in 2014 (trend χ(2)=11.96, P=0.001), similar to the trend in western countries. The proportion of infected patients who were not married increased from 18.75% to 42.21% (trend χ(2)=43.74, P=0.000). The top three source departments of HIV/AIDS cases were internal medicine (51.03%), emergency room (18.30%) and dermatology (13.53%). The proportion of the HIV/AIDS patients from department of gynecology and obstetrics declined from 18.75% in 2003 to 2.60% in 2014. No HIV/AIDS patients were detected in department of surgery, department of otorhinolaryngology, department of ophthalmology, department of stomatology and health examination center in 2003, but 14 cases (9.10%), 11 cases (7.14%) and 4 cases (2.60%) were detected in these departments respectively in 2014

  19. CM experts: hospitals need ED case managers now more than ever.

    PubMed

    2012-10-01

    It's no longer a luxury for hospitals to have case managers in their emergency departments, according to some case management experts--it's a necessity to make sure patients are admitted in the proper status and to ensure that those being discharged from the emergency department have what they need to manage their conditions. Hospitals need to ensure that patients meet medical necessity criteria to avoid losing reimbursement. Case managers can help provide a smooth transition from the emergency department back to the community and connect patients with post-discharge services. Case managers can work with patients who frequently utilize the emergency department and educate them about more appropriate venues of care.

  20. Deploying information technology and continuous control monitoring systems in hospitals to prevent medication errors.

    PubMed

    Escobar-Rodríguez, Tomás; Monge-Lozano, Pedro; Romero-Alonso, Ma Mercedes; Bolívar-Raya, Ma Antonia

    2012-01-01

    The serious repercussions of healthcare errors on patient safety have led hospitals to deploy information technology and continuous control monitoring systems to prevent them. Hospitals are moving away from traditional paper-based systems and focusing on designing new systems that prevent errors, using information technologies to catalyse the process re-engineering. This paper presents a case study that analyses the effect of computerised physician order entry and automated unit-based medication storage and distribution systems on the drug ordering and delivery process. It is concluded that information technology and continuous control monitoring systems have led to significant process re-engineering in the sequential stages of the drug ordering and delivery system. The new systems have also provided the opportunity to improve information available. This is an exploratory case study and the conclusions drawn from it offer possible routes for future research in this field.

  1. Failure of the merger of the Mount Sinai and New York University hospitals and medical schools: part 2.

    PubMed

    Kastor, John A

    2010-12-01

    This is the second of two articles in this issue of Academic Medicine that, together, report the author's findings from his study of the attempt by the leaders of Mount Sinai and New York University (NYU) medical centers in New York City to merge their medical schools and hospitals, and the failure of those attempts. After the unsuccessful effort of the trustees to merge the medical schools and hospitals--see the first article--the two institutions successfully created Mount Sinai NYU Health, a new company of the Mount Sinai and NYU hospitals in New York City. Members of the NYU faculty, worried that the new attempt would also include the medical schools, sued their university to prevent the merger. Although they lost the suit, the NYU medical school remained within the university as they had wanted. The hospital merger, like the more comprehensive hospital/medical school merger that failed, was favored by most of the trustees and executives at Mount Sinai. Although supported by many of the NYU trustees, both mergers were strongly opposed by some of the leadership and many of the faculty at the NYU medical center.The hospital merger came into effect in July 1998, but three years later, administration of the hospitals had returned to the separate campuses. In 2008, the merger was officially terminated. Although several of the back-office functions combined, no clinical programs did, as was also the case in other mergers of teaching hospitals. The author concludes with an analysis of why this merger failed while a few others succeeded.

  2. [Historical origins between National Medical Association of China and Boji Hospital in Guangzhou].

    PubMed

    Liu, Pinming

    2015-09-01

    In 2015, National Medical Association of China, now being called the Chinese Medical Association, celebrates its centennial and Boji Hospital in Guangzhou ( also known as Canton Hospital, or the Canton Pok Tsai Hospital, and now Sun Yat-sen Memorial Hospital of Sun Yat-sen University ) marks its 180th anniversary. Three major historical events establish the role of Boji Hospital in the founding and development of the National Medical Association of China during the last 100 years, viz.: ①hosting and participating in the establishment of the Medical Missionary Association of China and its official journal: the China Medical Missionary Journal; ②holding the 11th scientific sessions of the National Medical Association of China; ③nominating Dr. Wu Lien-teh as a candidate for the Nobel Prize in Physiology or Medicine in 1935 by William Warder Cadbury, the president of Boji Hospital.

  3. Linking Community Hospital Initiatives With Osteopathic Medical Students' Quality Improvement Training: A Pilot Program.

    PubMed

    Brannan, Grace D; Russ, Ronald; Winemiller, Terry R; Mast, Eric

    2016-01-01

    Quality improvement (QI) continues to be a health care challenge, and the literature indicates that osteopathic medical students need more training. To qualify for portions of managed care reimbursement, hospitals are required to meet measures intended to improve quality of care and patient satisfaction, which may be challenging for small community hospitals with limited resources. Because osteopathic medical training is grounded on community hospital experiences, an opportunity exists to align the outcomes needs of hospitals and QI training needs of students. In this pilot program, 3 sponsoring hospitals recruited and mentored 1 osteopathic medical student each through a QI project. A mentor at each hospital identified a project that was important to the hospital's patient care QI goals. This pilot program provided osteopathic medical students with hands-on QI training, created opportunities for interprofessional collaboration, and contributed to hospital initiatives to improve patient outcomes.

  4. Patient Perceptions of Provider and Hospital Factors Associated With New Medication Communication.

    PubMed

    Bartlett Ellis, Rebecca J; Bakoyannis, Giorgos; Haase, Joan E; Boyer, Kiersten; Carpenter, Janet S

    2016-09-01

    This research examined provider and hospital factors associated with patients' perceptions of how often explanations of new medications were "always" given to them, using Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores. HCAHPS results were obtained for October 2012 to September 2013, from 3,420 hospitals and combined with a Magnet-designated hospital listing. Multiple regression examined correlates of new medication communication, including health care provider factors (perceptions of nurse and physician communication) and health care system factors (magnet designation, hospital ownership, hospital type, availability of emergency services, and survey numbers). Nurse and physician communication was strongly associated with new medication communication (r = .819, p < .001; r = .722, p < .001, respectively). Multivariable correlates included nurse communication (p < .001), physician communication (p < .001), hospital ownership, availability of emergency services, and survey numbers. There was a significant relationship between patients' perceptions of nurse and physician communication and the explanations they had received about their new medications during hospitalization.

  5. [Study of morbidity in patients hospitalized at the Clinic Hospital at the Medical School of the USP-1989].

    PubMed

    Lebrão, M L; Litvoc, J; Figueiredo, G M; Leite, R M

    1993-01-01

    The diagnostic categories of the patients discharged from the "Hospital das Clínicas" of the University of São Paulo in 1989 were arranged according the International Classification of Diseases (I.C.D.) and analysed. In each Group sex, age and the reason of discharge or death was indicated. The data concerning 39,601 cases were provided by the Medical Data Service of the "Instituto Central" of the "Hospital das Clínicas". Only the principal diagnosis was taken into account. In the "Instituto de Psiquiatria" most the patients (55.4%) were males between 20 and 49 years of age. The main diagnostic categories were affective psychoses (20.3%), schizophrenic disorders (15%), and disorders related to alcoholism (9.5%). The mortality rate was 0.27%. In the "Instituto da Criança" 56% of the patients that left the hospital were male children and 45.8% of them were less than one year old. Regarding to the diagnostic categories the most important one was that of the diseases of the respiratory system with 27.1% of cases, followed by that of infectious and parasitic diseases with 16.0% of cases. Within the respiratory diseases the most important were the pneumonias caused by not specified microorganisms, and within the infectious diseases the most important was the diarrhea of presumably infectious origin. The mortality rate in this Institute was 9.4%. The "Instituto de Ortopedia e Traumatologia" left 3,825 patients 61.7% males, and 46.9% of them were aged between 20 and 49 years. The greatest number of cases (57.1%) belonged to the Chapter "Injury and Poisoning" followed by that of "Diseases of the Muscoleskeletal System" and Connective Tissue Diseases (23.5%). In this Institute the mortality rate was 1.2%. From the "Instituto do Coração" 7,194 patients were discharged; 65% of them were males, varying their age between 50 and 69 years. The diseases of the circulatory system were mostly ischemic heart disease, miocardiopathies and rheumatic heart diseases. Mortality rate

  6. The quality of medical record documentation and External cause of fall injury coding in a tertiary teaching hospital.

    PubMed

    Cunningham, Janet; Williamson, Dianne; Robinson, Kerin M; Carroll, Rhonda; Buchanan, Ross; Paul, Lindsay

    2014-01-01

    This paper reviews the documentation and coding of External causes of admitted fall cases in a major hospital. Intensive analysis of a random selection of 100 medical records included blind re-coding in the International Statistical Classification of Diseases and Related Health Problems, Tenth revision, Australian Modification (ICD-10-AM), Fifth Edition for External causes to ascertain whether: (i) the medical records contained sufficient information for assignment of specific External cause codes; and (ii) the most appropriate External cause codes were assigned per available documentation. Comparison of the hospital data with the state-wide Victorian Admitted Episodes Database (VAED) data on frequency of use of External cause codes revealed that the index hospital, a major trauma centre, treated comparatively more falls involving steps, stairs and ladders. The hospital sample reflected lower usage, than state-wide, of unspecified External cause codes and Other specified activity codes; otherwise, there was similarity in External cause coding. A comparison of researcher and hospital codes for the falls study sample revealed differences. The ambulance report was identified as the best source of External cause information; only 50% of hospital medical records contained sufficient information for specific code assignation for all three External cause codes, mechanism of injury, place of occurrence and activity at time of injury. Whilst all medical records contained mechanism of falls injury information, 16% contained insufficient details, indicating a deficiency in medical record documentation to underpin external cause coding. This was compounded by flaws in the ICD-10-AM classification.

  7. Effect of a Computerized Provider Order Entry (CPOE) System on medication orders at a community hospital and university hospital.

    PubMed

    Wess, Mark L; Embi, Peter J; Besier, James L; Lowry, Chad H; Anderson, Paul F; Besier, Chris J; Thelen, Geriann; Hegner, Catherine J

    2007-10-11

    Computerized Provider Order Entry (CPOE) has been demonstrated to improve the medication ordering process, but most published studies have been performed at academic hospitals. Little is known about the effects of CPOE at community hospitals. With a pre-post study design, we assessed the effects of a CPOE system on the medication ordering process at both a community and university hospital. The time from provider ordering to pharmacist verification decreased by two hours with CPOE at the community hospital (p<0.0001) and by one hour at the university hospital (p<0.0001). The rate of medication clarifications requiring signature was 2.80 percent pre-CPOE and 0.40 percent with CPOE (p<0.0001) at the community hospital. The university hospital was 2.76 percent pre-CPOE and 0.46 percent with CPOE (p<0.0001). CPOE improved medication order processing at both community and university hospitals. These findings add to the limited literature on CPOE in community hospitals.

  8. Effect of a Computerized Provider Order Entry (CPOE) System on Medication Orders at a Community Hospital and University Hospital

    PubMed Central

    Wess, Mark L.; Embi, Peter J.; Besier, James L.; Lowry, Chad H.; Anderson, Paul F.; Besier, James C.; Thelen, Geriann; Hegner, Catherine

    2007-01-01

    Computerized Provider Order Entry (CPOE) has been demonstrated to improve the medication ordering process, but most published studies have been performed at academic hospitals. Little is known about the effects of CPOE at community hospitals. With a pre-post study design, we assessed the effects of a CPOE system on the medication ordering process at both a community and university hospital. The time from provider ordering to pharmacist verification decreased by two hours with CPOE at the community hospital (p<0.0001) and by one hour at the university hospital (p<0.0001). The rate of medication clarifications requiring signature was 2.80 percent pre-CPOE and 0.40 percent with CPOE (p<0.0001) at the community hospital. The university hospital was 2.76 percent pre-CPOE and 0.46 percent with CPOE (p<0.0001). CPOE improved medication order processing at both community and university hospitals. These findings add to the limited literature on CPOE in community hospitals. PMID:18693946

  9. Medication-related patient harm in New Zealand hospitals.

    PubMed

    Robb, Gillian; Loe, Elizabeth; Maharaj, Ashika; Hamblin, Richard; Seddon, Mary E

    2017-08-11

    that medication-related harms are common, occur both in hospitals and in the community, and are a substantial burden for patients and our healthcare system. Work is underway at local and national levels to decrease this harm, with a focus on the high-risk medicines most commonly implicated.

  10. [Forced medical treatment: existent law and its limitations in a general hospital].

    PubMed

    Nitzan, Uri; Lev-Ran, Shaul; Phenig, Shmuel

    2011-04-01

    The conditions in which we can provide medical treatment without informed consent are detailed in the Israeli Law for Treating the Mentally Ill [1991), and the Law of Patient Rights (1996). Our clinicaL experience in a general hospital indicates that the law does not provide a satisfactory solution in cases where the patient is actively resisting emergency treatment. This may be the case for patients suffering from dementia, personality disorders or substance abuse disorders. Not infrequently, the physician finds himself perplexed in face of a genuine ethical/juridical dilemma, without being able to use the law efficiently or, at times, even implement it pragmatically. in this article, we review the array of laws by which Israeli physicians in general, and psychiatrists in particular, operate upon when deciding to treat a patient against his will in a general hospital. We describe and discuss a clinicaL case that raises fundamental questions concerning the existing law. We also discuss other complex cases, such as anorexia, debating the possibility of coercing medical treatment on someone who is not mentally ill--psychotic according to Israeli juridical system. Finally, we raise a few ideas as to how the present condition can be improved.

  11. Nursing, Pharmacy, and Prescriber Knowledge and Perceptions of High-Alert Medications in a Large, Academic Medical Hospital

    PubMed Central

    Engels, Melanie J.

    2015-01-01

    Background: High-alert medications pose a greater risk of causing significant harm to patients if used in error. The Joint Commission requires that hospitals define institution-specific high-alert medications and implement processes to ensure safe medication use. Method: Nursing, pharmacy, and prescribers were asked to voluntarily complete a 34-question survey to assess their knowledge, experience, and perceptions regarding high-alert medications in an academic hospital. Results: The majority of respondents identified the organization’s high-alert medications, the consequences of an error involving a high-alert medication, and the reversal agent. Most of the risk-reduction strategies within the institution were viewed as being effective by respondents. Forty-five percent of the respondents utilized a high-alert medication in the previous 24 hours. Only 14.2% had experienced an error with a high-alert medication in the previous 12 months, with 46% being near misses. The survey found the 5 rights for medication administration were not being utilized consistently. Respondents indicated that work experience or hospital orientation is the preferred learning experience for high-alert medications. Conclusions: This study assessed all disciplines involved in the medication use process. Perceptions about high-alert medications differ between disciplines. Ongoing discipline-specific education is required to ensure that individuals accept accountability in the medication use process and to close knowledge gaps on high-alert medications and risk-reduction strategies. PMID:26446747

  12. Initiation of a medical toxicology consult service at a tertiary care children’s hospital

    PubMed Central

    WANG, GEORGE SAM; MONTE, ANDREW; HATTEN, BENJAMIN; BRENT, JEFFREY; BUCHANAN, JENNIE; HEARD, KENNON J.

    2015-01-01

    Currently, only 10% of board-certified medical toxicologists are pediatricians. Yet over half of poison center calls involve children < 6 years, poisoning continues to be a common pediatric diagnosis and bedside toxicology consultation is not common at children’s hospitals. In collaboration with executive staff from Department of Pediatrics and Emergency Medicine, regional poison center, and our toxicology fellowship, we established a toxicology consulting service at our tertiary-care children’s hospital. There were 139 consultations, and the service generated 13 consultations in the first month; median of 11 consultations per month thereafter (range 8–16). The service increased pediatric cases seen by the fellowship program from 30 to 94. The transition to a consult service required a culture change. Historically, call center advice was the mainstay of consulting practice and the medical staff was not accustomed to the availability of bedside medical toxicology consultations. However, after promotion of the service and full attending and fellowship coverage, consultations increased. In collaboration with toxicologists from different departments, a consultation service can be rapidly established. The service filled a clinical need that was disproportionately utilized for high acuity patients, immediately utilized by the medical staff and provided a robust pediatric population for the toxicology fellowship. PMID:25686099

  13. Privatization of local public hospitals: effect on budget, medical service quality, and social welfare.

    PubMed

    Aiura, Hiroshi; Sanjo, Yasuo

    2010-09-01

    We analyze a duopolistic health care market in which a rural public hospital competes against an urban public hospital on medical quality, by using a Hotelling-type spatial competition model extended into a two-region model. We show that the rural public hospital provides excess quality for each unit of medical service as compared to the first-best quality, and the profits of the rural public hospital are lower than those of the urban public hospital because the provision of excess quality requires larger expenditure. In addition, we investigate the impact of the partial (or full) privatization of local public hospitals.

  14. Diagnostic error in children presenting with acute medical illness to a community hospital.

    PubMed

    Warrick, Catherine; Patel, Poonam; Hyer, Warren; Neale, Graham; Sevdalis, Nick; Inwald, David

    2014-10-01

    To determine incidence and aetiology of diagnostic errors in children presenting with acute medical illness to a community hospital. A three-stage study was conducted. Stage 1: retrospective case note review, comparing admission to discharge diagnoses of children admitted to hospital, to determine incidence of diagnostic error. Stage 2: cases of suspected misdiagnosis were examined in detail by two reviewers. Stage 3: structured interviews were conducted with clinicians involved in these cases to identify contributory factors. UK community (District General) hospital. All medical patients admitted to the paediatric ward and patients transferred from the Emergency Department to a different facility over a 90-day period were included. Incidence of diagnostic error, type of diagnostic error and content analysis of the structured interviews to determine frequency of emerging themes. Incidence of misdiagnosis in children presenting with acute illness was 5.0% (19/378, 95% confidence interval (CI) 2.8-7.2%). Diagnostic errors were multi-factorial in origin, commonly involving cognitive factors. Reviewers 1 and 2 identified a median of three and four errors per case, respectively. In 14 cases, structured interviews were possible; clinicians believed system-related errors (organizational flaws, e.g. inadequate policies, staffing or equipment) contributed more commonly to misdiagnoses, whereas reviewers found cognitive factors contributed more commonly to diagnostic error. Misdiagnoses occurred in 5% of children presenting with acute illness and were multi-factorial in aetiology. Multi-site longitudinal studies further exploring aetiology of errors and effect of educational interventions are required to generalize these findings and determine strategies for mitigation. © The Author 2014. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

  15. Using ArcGIS software in the pre-hospital emergency medical system.

    PubMed

    Manole, M; Duma, Odetta; Custură, Maria Alexandra; Petrariu, F D; Manole, Alina

    2014-01-01

    To measure the accessibility to healtcare services in order to reveal their quality and to improve the overall coverage, continuity and other features. We used the software ESRI Arc GIS 9.3, the Network Analyst function and data provided by Ambulance Service of Iasi (A.S.I.) with emergencies statistics for the first four months of 2012, processed by Microsoft Office Excel 2010. As examples, we chose "St. Maria" Children's Emergency Hospital and "St. Spiridon" Emergency Hospital. ArcGIS Network Analyst finds the best route to get from one location to another or a route that includes multiple locations. Each route is characterized by three stops. The starting point is always the office of Ambulance Service of Iasi (A.S.I.), a second stop at the case address and the third to the hospital unit chosen according to the patient's diagnosis and age. Spatial distribution of emergency cases for the first four months of 2012 in these two examples is one unequable, with higher concentrations in districts located in two areas of the city. The presented examples highlight the poor coverage of healthcare services for the population of Iasi, Romania, especially the South-West area and its vulnerability in situations of emergency. Implementing such a broad project would lead to more complex analyses that would improve the situation of pre-hospital emergency medical services, with final goal to deserve the population, improve the quality of healthcare and develop the interdisciplinary relationships.

  16. Knowledge of medical professionalism in medical students and physicians at Shahid Beheshti University of Medical Sciences and affiliated hospitals-Iran.

    PubMed

    Seif-Farshad, Mehran; Bazmi, Shabnam; Amiri, Farzad; Fattahi, Faeze; Kiani, Mehrzad

    2016-11-01

    Although medical professionalism is a fundamental aspect of competence in medicine and a distinct facet of physicians' competence, evidence suggests that the subject of professionalism is not taught or assessed as part of medical students' curricula in Iran and many other countries. Assessing the knowledge of medical students and physicians about medical professionalism seems to be helpful in identifying the weaknesses of training in the field of professionalism and devise plans for future training on the subject.The present cross-sectional, quantitative, observational, and prevalence study recruited 149 medical interns, clinical residents, physicians, and professors working in hospitals selected through stratified random sampling using a questionnaire designed by the researchers and confirmed for its validity and reliability. The results were analyzed by Stata at a significance level of 0.05.Out of 149 cases, 61.64% were male with the mean age of 30.81 years. A total of 66 participants (44.29%) (95% confidence interval [CI]: 36.44%-52.44%) had heard and 83 (55.70%) (95% CI: 47.55%-63.55%) had not heard the term "medical professionalism" before the study. After adjusting for potential confounders, age and degree did not have statistically significant difference in assessed knowledge of medical professionalism, but sex had (mean difference: 5.88, P = 0.045), and the mean of the female was significantly higher than that of the male participants. The mean percentage of correct answers was 47.67.The present study demonstrated that the medical professionals working in the national healthcare system have an unfavorable theoretical knowledge about medical professionalism in Iran; although this does not indicate that their practices are unethical, it should be noted that one of the prerequisites of possessing a high level of medical professionalism and for establishing a proper relationship between the medical community and the patients is to have a proper knowledge of

  17. [A rare case of tubercular tenosynovitis in hospital surgeon as a result of an occupational accident caused by puncture with an infected needle. Prevention aspects and legal-medical evaluation].

    PubMed

    Delli Carri, R; Piscozzi, Paola; Massimelli, M; Falcetta, R

    2010-01-01

    The subject was a hospital surgeon who, in the course of routine outpatient surgery with aspiration to collect right lumbar material in a patient with suspected TB infection, accidentally punctured the fifth finger of the left hand with the needle used for this procedure. This led to involvement of the fifth finger of the left hand restricted to the soft tissue with preservation of joint and bone and tenosynovial involvement of the entire extremity. To draw attention to the repercussions for insurance with resulting absence from work for 126 days and an assessment of biological impairment of 2% by the Insurance Institute (INAIL). A case report is described of rare occupational tubercular synovitis. A rare event is reported that occurred in a senior staff member with particular insurance repercussions.

  18. Measles Cases in Children Requiring Hospital Access in an Academic Pediatric Hospital in Italy, 2008-2013.

    PubMed

    Ciofi Degli Atti, Marta; Filia, Antonietta; Bella, Antonino; Sisto, Annamaria; Barbieri, Maria Antonietta; Reale, Antonino; Raponi, Massimiliano

    2017-09-01

    The Lazio region is one of the Italian regions where sustained measles transmission continues to occur. We investigated measles cases reported by the emergency department (ED) of the largest pediatric hospital in Italy, located in Lazio. We reviewed clinical records of all measles cases from 0 to 18 years of age evaluated in the ED in 2008-2013. We compared demographic and clinical characteristics of patients admitted to the inpatient setting with those of patients discharged home to assess possible determinants of hospital admission. Of 248 patients with measles evaluated in the ED, 113 (45.6%) were admitted as inpatients. The number of measles cases peaked in 2011 (N = 122; 49.2%), when epidemics were reported in Lazio. Median age was 2.7 years (range: 21 days to 17.9 years), and 31 patients (13%) had an underlying chronic illness. The strongest independent predictor of hospitalization was having an underlying chronic illness [adjusted odd ratio (OR): 9.87; 95% confidence interval: 3.13-31.13]. Other factors independently and significantly associated with higher risk of hospitalization were taking medications at the time of ED visit, being younger than 1 year of age and having altered liver enzyme values. Eighty-five percent of children >15 months of age who were hospitalized were not vaccinated. One hundred six hospitalized children (94%) had at least 1 measles complication; 1 child required intensive care for respiratory insufficiency. Hospitalizations of children with measles continue to occur in European areas where elimination has not been achieved. Children with chronic diseases represent a vulnerable population that is at higher risk of hospitalization.

  19. Effect of costing methods on unit cost of hospital medical services.

    PubMed

    Riewpaiboon, Arthorn; Malaroje, Saranya; Kongsawatt, Sukalaya

    2007-04-01

    To explore the variance of unit costs of hospital medical services due to different costing methods employed in the analysis. Retrospective and descriptive study at Kaengkhoi District Hospital, Saraburi Province, Thailand, in the fiscal year 2002. The process started with a calculation of unit costs of medical services as a base case. After that, the unit costs were re-calculated based on various methods. Finally, the variations of the results obtained from various methods and the base case were computed and compared. The total annualized capital cost of buildings and capital items calculated by the accounting-based approach (averaging the capital purchase prices throughout their useful life) was 13.02% lower than that calculated by the economic-based approach (combination of depreciation cost and interest on undepreciated portion over the useful life). A change of discount rate from 3% to 6% results in a 4.76% increase of the hospital's total annualized capital cost. When the useful life of durable goods was changed from 5 to 10 years, the total annualized capital cost of the hospital decreased by 17.28% from that of the base case. Regarding alternative criteria of indirect cost allocation, unit cost of medical services changed by a range of -6.99% to +4.05%. We explored the effect on unit cost of medical services in one department. Various costing methods, including departmental allocation methods, ranged between -85% and +32% against those of the base case. Based on the variation analysis, the economic-based approach was suitable for capital cost calculation. For the useful life of capital items, appropriate duration should be studied and standardized. Regarding allocation criteria, single-output criteria might be more efficient than the combined-output and complicated ones. For the departmental allocation methods, micro-costing method was the most suitable method at the time of study. These different costing methods should be standardized and developed as

  20. ERP implementation in hospitals: a case study.

    PubMed

    Agarwal, Divya; Garg, Poonam

    2012-01-01

    In a competitive healthcare sector, hospitals have to focus on their processes in order to deliver high-quality care while at the same time reducing costs. Many hospitals have decided to adopt one or another Enterprise Resource Planning (ERP) system to improve their businesses, but implementing an ERP system can be a demanding endeavour. The systems are so difficult to implement that some are successful; many have failed, causing multimillion dollar losses. The challenge of ERP solutions lie in implementation because they are complex, time consuming and expensive too. This paper describes the various process workflows and phases of ERP implementation at Fortis Hospital Cunningham Road, Bangalore, India. This knowledge will provide valuable insights for the researchers and practitioners to understand the different process workflows and to make informed decisions when implementing ERP in any hospital.

  1. The relationship between transformational leadership and social capital in hospitals--a survey of medical directors of all German hospitals.

    PubMed

    Hammer, Antje; Ommen, Oliver; Röttger, Julia; Pfaff, Holger

    2012-01-01

    The German hospital market has been undergoing major changes in recent years. Success in this new market is determined by a multitude of factors. One is the quality of the social relationships between staff and the presence of shared values and rules. This factor can be considered an organization's "social capital." This study investigates the relationship between social capital and leadership style in German hospitals using a written survey of medical directors. In 2008, a cross-sectional representative study was conducted with 1224 medical directors from every hospital in Germany with at least 1 internal medicine unit and 1 surgery unit. Among the scales included in the standardized questionnaire were scales used to assess the medical directors' evaluation of social capital and transformational leadership in the hospital. We used a multiple linear regression model to examine the relationship between social capital and internal coordination. We controlled for hospital ownership, teaching status, and number of beds. In total, we received questionnaires from 551 medical directors, resulting in a response rate of 45.2%. The participating hospitals had an average of 345 beds. The sample included public (41.3%), not-for-profit (46.9%), and for-profit (11.7%) hospitals. The data, which exclusively represent the perceptions of the medical directors, indicate a significant correlation between a transformational leadership style of the executive management and the social capital as perceived by medical directors. A transformational leadership style of the executive management accounted for 36% of variance of the perceived social capital. The perceived social capital in German hospitals is closely related to the leadership style of the executive management. A transformational leadership style of the executive management appears to successfully strengthen the hospital's social capital.

  2. The Treatment of Anorexia Nervosa in a General Hospital: A Case Vignette of a Multi-Disciplinary General Hospital-Based Approach.

    ERIC Educational Resources Information Center

    Kronenberg, J.; And Others

    1994-01-01

    Describes anorexia nervosa as condition variable in etiology and resistant to treatment, which may lead to mortality in 5% of treated cases. Notes that efforts have been made for treating disorder in nonstigmatizing medical units outside psychiatric hospitals. Describes, through presentation of short case vignette, advantages of treating…

  3. The Treatment of Anorexia Nervosa in a General Hospital: A Case Vignette of a Multi-Disciplinary General Hospital-Based Approach.

    ERIC Educational Resources Information Center

    Kronenberg, J.; And Others

    1994-01-01

    Describes anorexia nervosa as condition variable in etiology and resistant to treatment, which may lead to mortality in 5% of treated cases. Notes that efforts have been made for treating disorder in nonstigmatizing medical units outside psychiatric hospitals. Describes, through presentation of short case vignette, advantages of treating…

  4. Case mix planning in hospitals: a review and future agenda.

    PubMed

    Hof, Sebastian; Fügener, Andreas; Schoenfelder, Jan; Brunner, Jens O

    2017-06-01

    The case mix planning problem deals with choosing the ideal composition and volume of patients in a hospital. With many countries having recently changed to systems where hospitals are reimbursed for patients according to their diagnosis, case mix planning has become an important tool in strategic and tactical hospital planning. Selecting patients in such a payment system can have a significant impact on a hospital's revenue. The contribution of this article is to provide the first literature review focusing on the case mix planning problem. We describe the problem, distinguish it from similar planning problems, and evaluate the existing literature with regard to problem structure and managerial impact. Further, we identify gaps in the literature. We hope to foster research in the field of case mix planning, which only lately has received growing attention despite its fundamental economic impact on hospitals.

  5. Risk factors for hospital-acquired infections in teaching hospitals of Amhara regional state, Ethiopia: A matched-case control study.

    PubMed

    Yallew, Walelegn Worku; Kumie, Abera; Yehuala, Feleke Moges

    2017-01-01

    Hospital-acquired infection affects hundreds of millions of people worldwide. It is a major global issue for patient safety. Understanding the potential risk factors is important to appreciate the local context. A matched case control study design, which is the first of its kind in the study region, was undertaken to identify risk factors in teaching hospitals of Amhara regional state, Ethiopia. A matched case control study design matched with age and hospital type was used. The study was conducted in University of Gondar and Felege-Hiwot medical teaching hospital. Cases were patients who fulfilled the criteria based on CDC definition of hospital-acquired infection and controls were patients admitted to the hospital that stayed for more than 48 hours in the ward in the study period, but who did not develop infection. For one case, four controls were selected. Of 545 patients, 109 were cases and 436 were controls. Conditional logistic regression using STATA 13 was used for data analysis. The median length of stay for cases and controls was 7 and 8 days, respectively. Patients admitted in wards with the presence of medical waste container in the room had 82% less chance of developing hospital-acquired infection (AOR 0.18; 95% CI, 0.03-0.98). The odds of developing hospital-acquired infection among immune deficient patients were 2.34 times higher than their counterparts (95% CI; 1.17-4.69). Patients received antimicrobials, central vascular catheter and surgery since admission had 8.63, 6.91 and 2.35 higher odds of developing hospital-acquired infection, respectively. Health providers and mangers should consider the provision and availability of healthcare materials and facilities in all of the ward rooms, follow appropriate safe medical procedures for use of external devices on patients, and give attention to the immunocompromised patients for the prevention and control of hospital-acquired infections.

  6. Comparing patients who leave the ED prematurely, before vs after medical evaluation: a National Hospital Ambulatory Medical Care Survey analysis.

    PubMed

    Moe, Jessica; Belsky, Justin Brett

    2016-05-01

    Many patients leave the Emergency Department (ED) before beginning or completing medical evaluation. Some of these patients may be at higher medical risk depending on their timing of leaving the ED. To compare patient, hospital, and visit characteristics of patients who leave before completing medical care to patients who leave before ED evaluation. Retrospective cross-sectional analysis of ED visits using the 2009-2011 National Hospital Ambulatory Medical Care Survey. A total of 100962 ED visits were documented in the 2009-2011 National Hospital Ambulatory Medical Care Survey, representing a weighted count of 402211907 total ED visits. 2646 (2.62%) resulted in a disposition of left without completing medical care. Of these visits, 1792 (67.7%) left before being seen by a medical provider versus 854 (32.3%) who left after medical provider evaluation but before a final disposition. Patients who left after being assessed by a medical provider were older, had higher acuity visits, were more likely to have visited an ED without nursing triage, arrived more often by ambulance, and were more likely to have private insurance than to be self-paying or to have other payment arrangements (e.g. worker's compensation or charity/no charge). When comparing all patients who left the ED before completion of care, those who left after versus before medical provider evaluation differed in their patient, hospital, and visit characteristics and may represent a high risk patient group. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Medication discrepancy and potentially inappropriate medication in older Chinese-American home-care patients after hospital discharge.

    PubMed

    Hu, Sophia H; Capezuti, Elizabeth; Foust, Janice B; Boltz, Marie P; Kim, Hongsoo

    2012-10-01

    Studies of potential medication problems among older adults have focused on English-speaking populations in a single health care setting or a single potential medication problem. No previous studies investigated potential inappropriate medications (PIMs) and medication discrepancies (MDs) among older Chinese Americans during care transitions from hospital discharge to home care. The aims of this study were to examine, in older Chinese Americans, the prevalence of both PIMs and MDs; the relationship between PIMs and MDs; and the patient and hospitalization characteristics associated with them during care transitions from hospital discharge to home care. This cross-sectional study was conducted with a sample of older Chinese Americans from a large certified nonprofit home-care agency in New York City from June 2010 to July 2011. PIMs were identified by using 2002 diagnosis-independent Beers criteria. MDs were identified by comparing the differences between hospital discharge medication order and home-care admission medication order. Prevalence of PIMs and MDs and their relationship was determined. Logistic regression examined the relationship between hospitalization and patient characteristics with PIMs and MDs. The sample consisted of 82 older Chinese-American home-care patients. Twenty (24.3%) study participants were prescribed at least one PIM at hospital discharge. Fifty-one (67.1%) study participants experienced at least one MD. A positive correlation was found between the occurrence of PIMs and MDs (r = 0.22; P = 0.05). Number of medications was the only significant factor associated with both PIMs and MDs. In addition, older age and more hospitalization days were associated with PIMs. The evident prevalence of PIMs and MDs supports the practice of evaluating the appropriateness of medications while reconciling inconsistencies in medication regimens. The number of medications was the only factor associated with both PIMs and MDs, underscoring the need to

  8. Factor structure of the SOCRATES questionnaire in hospitalized medical patients.

    PubMed

    Bertholet, Nicolas; Dukes, Kim; Horton, Nicholas J; Palfai, Tibor P; Pedley, Alison; Saitz, Richard

    2009-01-01

    The Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES), a 19-item instrument developed to assess readiness to change alcohol use among individuals presenting for specialized alcohol treatment, has been used in various populations and settings. Its factor structure and concurrent validity has been described for specialized alcohol treatment settings and primary care. The purpose of this study was to determine the factor structure and concurrent validity of the SOCRATES among medical inpatients with unhealthy alcohol use not seeking help for specialized alcohol treatment. The subjects were 337 medical inpatients with unhealthy alcohol use, identified during their hospital stay. Most of them had alcohol dependence (76%). We performed an Alpha Factor Analysis (AFA) and Principal Component Analysis (PCA) of the 19 SOCRATES items, and forced 3 factors and 2 components, in order to replicate findings from Miller and Tonigan (Miller, W. R., & Tonigan, J. S., (1996). Assessing drinkers' motivations for change: The Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES). Psychology of Addictive Behavior, 10, 81-89.) and Maisto et al. (Maisto, S. A., Conigliaro, J., McNeil, M., Kraemer, K., O'Connor, M., & Kelley, M. E., (1999). Factor structure of the SOCRATES in a sample of primary care patients. Addictive Behavior, 24(6), 879-892.). Our analysis supported the view that the 2 component solution proposed by Maisto et al. (Maisto, S.A., Conigliaro, J., McNeil, M., Kraemer, K., O'Connor, M., & Kelley, M.E., (1999). Factor structure of the SOCRATES in a sample of primary care patients. Addictive Behavior, 24(6), 879-892.) is more appropriate for our data than the 3 factor solution proposed by Miller and Tonigan (Miller, W. R., & Tonigan, J. S., (1996). Assessing drinkers' motivations for change: The Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES). Psychology of Addictive Behavior, 10, 81-89.). The first component measured

  9. [Survey of medical care resources of acute myocardial infarction in different regions and levels of hospitals in China].

    PubMed

    Sun, H; Yang, Y J; Xu, H Y; Yang, J G; Gao, X J; Wu, Y; Li, W; Wang, Y; Liu, J; Jin, C; Song, L

    2016-07-24

    To investigate the medical care resources of acute myocardial infarction (AMI) in Chinese hospitals of different regions and levels. We selected 115 hospitals in China, including 61 northern hospitals, 54 southern hospitals, 52 eastern hospitals, 26 central hospitals, 37 western hospitals, 79 tertiary hospitals, 36 secondary hospitals, 34 pro vincial-level hospitals, 46 prefectural-level hospitals and 35 county hospitals. From November 2012 to August 2013, we sent questionnaire to the cardiologists in each hospital, to collect related information. (1) The number of AMI admitted each year of northern hospital was more than the number of southern hospital (220 (120, 400) cases vs. 220 (80, 350) cases, P=0.033), while number of coronary care unit (CCU), thrombolytic therapy, percutaneous coronary intervention (PCI), primary PCI and coronary artery bypass grafting (CABG) were similar (all P> 0.05). (2) The number of AMI admitted each year of eastern, central and western hospital was 295(150, 501) cases, 175(75, 300) cases and 170(50, 250) cases respectively(P=0.007), with no significant difference among them for setting CCU, carrying out thrombolytic therapy, PCI, primary PCI and CABG (all P>0.05). (3) The total number of the in-patient beds and AMI admitted each year of tertiary hospitals were significantly higher than that in the secondary hospitals(104(70, 152)vs. 47(30, 52), P<0.001) and (300(200, 460)cases vs.80(47, 135)cases, P<0.001) respectively. There was a significant difference between tertiary and secondary hospitals for the number of CCU (97.5% (77/79)and 75.0%(27/36)), PCI (98.7%(78/79)and 27.8%(10/36)), primary PCI (96.2%(76/79)and 22.2%(8/36)), CABG (81.0%(64/79)and 11.1%(4/36)), intra-aortic balloon pump (IABP) (91.1%(72/79) and 13.9%(5/36)) respectively (all P<0.001). (4) There were obvious differences among provincial-level, prefectural-level and country-level hospitals for the admitted AMI patient numbers annually which was 400(250, 600), 232

  10. Hospital Information System Support for the Medical Decision Maker

    PubMed Central

    Mishelevich, David J.; Atkinson, Jack B.; Noland, Robert L.; Eisenberg, Jerry R.

    1981-01-01

    This paper describes the early stages in migration toward a comprehensive, on-line Hospital Information System with emphasis placed on the needs of the physician and other Medical Decision Makers. Such systems will properly put the computing power where it belongs: in the hands of the user, to the decision being made, to enhance health professional productivity and cost effectiveness. Thus we are evolving to such feedback to the physician in multiple dimensions, whether previous orders and/or results, patient profiles, cost of item ordered, potential drug-drug and drug-laboratory test interactions, potential duplicate examinations, or other information are involved. Considerations for systems which can potentially meet these needs are outlined. Specific examples of characteristics of the IBM Patient Care System {PCS} are presented as a prototypical model. Critical components are the presence of relevant data and the human-engineered, user-cordial access to that data. Coverage is given to multiple existing and potential sources of clinically-significant data whether manual or automated instrument input are involved.

  11. The 2012 derecho: emergency medical services and hospital response.

    PubMed

    Kearns, Randy D; Wigal, Mark S; Fernandez, Antonio; Tucker, March A; Zuidgeest, Ginger R; Mills, Michael R; Cairns, Bruce A; Cairns, Charles B

    2014-10-01

    During the early afternoon of June 29, 2012, a line of destructive thunderstorms producing straight line winds known as a derecho developed near Chicago (Illinois, USA). The storm moved southeast with wind speeds recorded from 100 to 160 kilometers per hour (kph, 60 to 100 miles per hour [mph]). The storm swept across much of West Virginia (USA) later that evening. Power outage was substantial as an estimated 1,300,000 West Virginians (more than half) were without power in the aftermath of the storm and approximately 600,000 citizens were still without power a week later. This was one of the worst storms to strike this area and occurred as residents were enduring a prolonged heat wave. The wind damage left much of the community without electricity and the crippling effect compromised or destroyed critical infrastructure including communications, air conditioning, refrigeration, and water and sewer pumps. This report describes utilization of Emergency Medical Services (EMS) and hospital resources in West Virginia in response to the storm. Also reported is a review of the weather phenomena and the findings and discussion of the disaster and implications.

  12. Case management for medical aid beneficiaries in Korea: findings from case-control study.

    PubMed

    Shin, Hee-Sun; Oh, Jin-Joo

    2014-12-01

    This study was to evaluate effects of case management provided for 7 months for medical aid in Korea. This study was a retrospective comparative study using secondary data analysis. Data from two pre-existing survey were reanalyzed. The data were collected through door to-door interviews using the structured questionnaire. For the medical service use, claims data from the Korea National Health Insurance Corporation was used. Subjects were 73 in the intervention group and 118 in the control group. There was no significant change in the intervention group in self-care ability (p = .296), medication adherence (p = .194) or quality of life (p = .903) compared to those of the control group. For hospital visiting days, it appeared to decrease in the intervention group (p = .038) but with no significant difference from that of the control group (p = .157). Neither were there significant differences in medical expenditures (p = .605). Although the effect of case management in this study appeared extremely limited, the short intervention period and characteristics of the medical aid beneficiaries and the limit of controlling only the demand side were discussed as factors to be considered. Nurses have been carrying out professional roles in case management in Korea. However more efforts are needed to develop case management as an area for nursing specialization. Copyright © 2014. Published by Elsevier B.V.

  13. Medical staff contracting: legal issues in physician-hospital arrangements.

    PubMed

    Caesar, N B

    1993-01-01

    This article--the third in a series analyzing the physician-hospital contracting process from the physician's perspective--addresses the legal issues involved in physician-hospital arrangements, including those arising under federal and state illegal remuneration, antitrust, and tax laws. New applications of these issues to physician-hospital organizations and practice management/practice acquisitions by hospitals are also addressed, as well as other recent hospital efforts to maximize the benefits to be gained from the physician-hospital relationship.

  14. Reliability and Validity in Hospital Case-Mix Measurement

    PubMed Central

    Pettengill, Julian; Vertrees, James

    1982-01-01

    There is widespread interest in the development of a measure of hospital output. This paper describes the problem of measuring the expected cost of the mix of inpatient cases treated in a hospital (hospital case-mix) and a general approach to its solution. The solution is based on a set of homogenous groups of patients, defined by a patient classification system, and a set of estimated relative cost weights corresponding to the patient categories. This approach is applied to develop a summary measure of the expected relative costliness of the mix of Medicare patients treated in 5,576 participating hospitals. The Medicare case-mix index is evaluated by estimating a hospital average cost function. This provides a direct test of the hypothesis that the relationship between Medicare case-mix and Medicare cost per case is proportional. The cost function analysis also provides a means of simulating the effects of classification error on our estimate of this relationship. Our results indicate that this general approach to measuring hospital case-mix provides a valid and robust measure of the expected cost of a hospital's case-mix. PMID:10309909

  15. Effects of asymmetric medical insurance subsidy on hospitals competition under non-price regulation.

    PubMed

    Wang, Chan; Nie, Pu-Yan

    2016-11-15

    Poor medical care and high fees are two major problems in the world health care system. As a result, health care insurance system reform is a major issue in developing countries, such as China. Governments should take the effect of health care insurance system reform on the competition of hospitals into account when they practice a reform. This article aims to capture the influences of asymmetric medical insurance subsidy and the importance of medical quality to patients on hospitals competition under non-price regulation. We establish a three-stage duopoly model with quantity and quality competition. In the model, qualitative difference and asymmetric medical insurance subsidy among hospitals are considered. The government decides subsidy (or reimbursement) ratios in the first stage. Hospitals choose the quality in the second stage and then support the quantity in the third stage. We obtain our conclusions by mathematical model analyses and all the results are achieved by backward induction. The importance of medical quality to patients has stronger influence on the small hospital, while subsidy has greater effect on the large hospital. Meanwhile, the importance of medical quality to patients strengthens competition, but subsidy effect weakens it. Besides, subsidy ratios difference affects the relationship between subsidy and hospital competition. Furthermore, we capture the optimal reimbursement ratio based on social welfare maximization. More importantly, this paper finds that the higher management efficiency of the medical insurance investment funds is, the higher the best subsidy ratio is. This paper states that subsidy is a two-edged sword. On one hand, subsidy stimulates medical demand. On the other hand, subsidy raises price and inhibits hospital competition. Therefore, government must set an appropriate subsidy ratio difference between large and small hospitals to maximize the total social welfare. For a developing country with limited medical resources

  16. [Issues related to national university medical schools: focusing on the low wages of university hospital physicians].

    PubMed

    Takamuku, Masatoshi

    2015-01-01

    University hospitals, bringing together the three divisions of education, research, and clinical medicine, could be said to represent the pinnacle of medicine. However, when compared with physicians working at public and private hospitals, physicians working at university hospitals and medical schools face extremely poor conditions. This is because physicians at national university hospitals are considered to be "educators." Meanwhile, even after the privatization of national hospitals, physicians working for these institutions continue to be perceived as "medical practitioners." A situation may arise in which physicians working at university hospitals-performing top-level medical work while also being involved with university and postgraduate education, as well as research-might leave their posts because they are unable to live on their current salaries, especially in comparison with physicians working at national hospitals, who focus solely on medical care. This situation would be a great loss for Japan. This potential loss can be prevented by amending the classification of physicians at national university hospitals from "educators" to "medical practitioners." In order to accomplish this, the Japan Medical Association, upon increasing its membership and achieving growth, should act as a mediator in negotiations between national university hospitals, medical schools, and the government.

  17. Mediating medical malpractice lawsuits against hospitals: New York City's Pilot Project.

    PubMed

    Hyman, Chris Stern; Schechter, Clyde B

    2006-01-01

    The New York City Health and Hospitals Corporation participated in a feasibility study to measure the participants' satisfaction with mediation of medical malpractice lawsuits. Twenty-nine cases were referred to the study, twenty-four agreed to mediation, and nineteen were mediated. Satisfaction data indicate that the plaintiffs and their attorneys and the defendant's attorney were satisfied with the process whether or not settlement was reached. The mean length of a mediation was 2.34 hours. Of the cases mediated, thirteen settled, with a median payment of 111,000 dollars. The defendant's and plaintiffs' attorneys estimated spending approximately one-tenth the amount of time preparing their case for mediation that they would have spent preparing for trial.

  18. 38 CFR 17.49 - Priorities for outpatient medical services and inpatient hospital care.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Priorities for outpatient medical services and inpatient hospital care. 17.49 Section 17.49 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.49 Priorities for...

  19. 38 CFR 17.49 - Priorities for outpatient medical services and inpatient hospital care.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2014-07-01 2014-07-01 false Priorities for outpatient medical services and inpatient hospital care. 17.49 Section 17.49 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.49 Priorities for...

  20. 38 CFR 17.49 - Priorities for outpatient medical services and inpatient hospital care.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2012-07-01 2012-07-01 false Priorities for outpatient medical services and inpatient hospital care. 17.49 Section 17.49 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.49 Priorities for...

  1. 38 CFR 17.49 - Priorities for outpatient medical services and inpatient hospital care.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Priorities for outpatient medical services and inpatient hospital care. 17.49 Section 17.49 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.49 Priorities for...

  2. 38 CFR 17.49 - Priorities for outpatient medical services and inpatient hospital care.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2013-07-01 2013-07-01 false Priorities for outpatient medical services and inpatient hospital care. 17.49 Section 17.49 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.49 Priorities for...

  3. Continuing Medical Education in Community Hospitals: A Manual for Program Development.

    ERIC Educational Resources Information Center

    Stearns, Norman S.; And Others

    1971-01-01

    This manual provides guidelines for: (1) developing community hospital-based programs of continuing medical education; and (2) delivering education consultation to community hospitals. Chapters I and II outline principles of continuing medical education, present a model for education program development, and provide specific how-to techniques and…

  4. Medical trainees' formal and informal incident reporting across a five-hospital academic medical center.

    PubMed

    Logio, Lia S; Ramanujam, Rangaraj

    2010-01-01

    Despite the importance of incident reporting for promoting patient safety, the extent to which residents and fellows (trainees) in graduate medical education (GME) programs report incidents is not well understood. A study was conducted to determine the prevalence of and variations in incident reporting across hospitals in an academic medical center. Trainees enrolled in GME programs sponsored by the Indiana University School of Medicine (IUSM) completed (1) the Behavior Index Survey (BIS), which asked respondents if they knew how to locate incident forms and if they ever submitted an incident form, and (2) the Safety Culture Survey (SCS), which asked about the frequencies of their formal and informal incident reporting behaviors. Some 443 of 992 invited trainees (45% response rate) participated in the study. Of the 305 BIS respondents who rotated through all five hospitals, varying proportions knew how to locate an incident form (22.3%-31.5%) and had completed an incident form (6.2%-20%) in each hospital. Incident report completion rates were higher (20.1%-81.3%) among trainees who knew how to locate an incident form. Higher proportions of the 443 SCS respondents had informally discussed an incident with other trainees (90%), faculty physicians (70%), and at resident meetings and conferences (73%). The study confirms that GME trainees formally report incidents rarely. The flow of communication to and from trainees about patient safety and incidents is low, despite an organizational focus on safety and quality. Discussion of safety issues among trainees occurs more informally among colleagues and peers than with faculty or through formal reporting mechanisms. The data suggest a number of strategies to increase the culture of safety among GME trainees.

  5. Prevalence of hospital-acquired infections in the university medical center of Rabat, Morocco

    PubMed Central

    2012-01-01

    Background The aims of this study were to determine the hospital-acquired infections (HAI) prevalence in all institutions of Rabat University Medical Center, to ascertain risk factors, to describe the pathogens associated with HAI and their susceptibility profile to antibiotics. Materials and methods Point-prevalence survey in January 2010 concerning all patients who had been in the hospital for at least 48 hours. At bedside, 27 investigators filled a standardized questionnaire from medical records, temperature charts, radiographs, laboratory reports and by consultation with the ward’s collaborating health professionals. Risk factors were determined using logistic regression. Results 1195 patients involved, occupancy rate was 51%. The prevalence of HAI was 10.3%. Intensive care units were the most affected wards (34.5%). Urinary tract infection was the most common infected site (35%). Microbiological documentation was available in 61% of HAI. Staphylococcus was the organism most commonly isolated (18.7%) and was methicillin-resistant in 50% of cases. In multivariate analysis, risk factors associated with HAI were advanced age, longer length of hospital stay, presence of comorbidity, invasive devices and use of antibiotic use. Conclusion HAI prevalence was high in this study. Future prevention program should focus on patients with longer length of stay, invasive devices, and overprescribing antibiotics. PMID:23031793

  6. Innovative medical devices and hospital decision making: a study comparing the views of hospital pharmacists and physicians.

    PubMed

    Billaux, Mathilde; Borget, Isabelle; Prognon, Patrice; Pineau, Judith; Martelli, Nicolas

    2016-06-01

    Objectives Many university hospitals have developed local health technology assessment processes to guide informed decisions about new medical devices. However, little is known about stakeholders' perceptions and assessment of innovative devices. Herein, we investigated the perceptions regarding innovative medical devices of their chief users (physicians and surgeons), as well as those of hospital pharmacists, because they are responsible for the purchase and management of sterile medical devices. We noted the evaluation criteria used to assess and select new medical devices and suggestions for improving local health technology assessment processes indicated by the interviewees. Methods We randomly selected 18 physicians and surgeons (nine each) and 18 hospital pharmacists from 18 French university hospitals. Semistructured interviews were conducted between October 2012 and August 2013. Responses were coded separately by two researchers. Results Physicians and surgeons frequently described innovative medical devices as 'new', 'safe' and 'effective', whereas hospital pharmacists focused more on economic considerations and considered real innovative devices to be those for which no equivalent could be found on the market. No significant difference in evaluation criteria was found between these groups of professionals. Finally, hospital pharmacists considered the management of conflicts of interests in local health technology assessment processes to be an issue, whereas physicians and surgeons did not. Conclusions The present study highlights differences in perceptions related to professional affiliation. The findings suggest several ways in which current practices for local health technology assessment in French university hospitals could be improved and studied. What is known about the topic? Hospitals are faced with ever-growing demands for innovative and costly medical devices. To help hospital management deal with technology acquisition issues, hospital

  7. Potential for radioactive patient excreta in hospital trash and medical waste

    SciTech Connect

    Evdokimoff, V.; Cash, C.; Buckley, K.

    1994-02-01

    Radioactive excreta from nuclear medicine patients can enter solid waste as common trash and medical biohazardous waste. Many landfills and transfer stations now survey these waste streams with scintillation detectors which may result in rejection of a hospital`s waste. Our survey indicated that on the average either or both of Boston University Medical Center Hospital`s waste streams can contain detectable radioactive excreta on a weekly basis. To avoid potential problems, radiation detectors were installed in areas where housekeepers carting trash and medical waste must pass through to ensure no radioactivity leaves the institution. 3 refs.

  8. [Medication error due to drug packaging: a case report].

    PubMed

    Hélène', Ginestet; David, Breton; Sophie, Spadoni; Vincent, Jandard; Michel, Paillet; Xavier, Bohand

    2009-12-01

    Nowadays, occurrence of medication errors is a public health concern at hospital. Drug packaging represent one of the important causes of medication errors. The authors report a medication error associated with an erroneous interpretation of drug packaging information. This error was detected during the pharmaceutical review of the medical prescription. The nursing staff in charge of drug administering must thus be particularly aware of this risk. The potential clinical significance of this type of medication error may be important.

  9. Comparison of advance medical directive inquiry and documentation for hospital inpatients in three medical services: implications for policy changes.

    PubMed

    Anunobi, Echezona; Detweiler, Mark B; Sethi, Roopa; Thomas, Reena; Lutgens, Brian; Detweiler, Jonna G

    2015-01-01

    Following the introduction of the Patient Self-Determination Act of 1990, the Veterans Health Administration developed its own advance medical directive (AMD) policy, which most recently states that documentation is mandatory for all hospital patients in all settings. The object of this study was to assess the effectiveness of AMD documentation at a local Veterans Affairs Medical Center. AMD documentation was compared among three inpatient services: surgery, medicine, and psychiatry. Retrospective in nature, 594 inpatient cases were compared. Results revealed that, overall, the rate of AMD documentation was 37.7%. AMD documentation on surgery was statistically more frequent (45.6%) than for either medicine (33.2%) or psychiatry (34.5%). The difference between the numbers of days to AMD documentation for all three services was not statistically significant. While there was no statistically significant difference across gender, Caucasians had AMDs documented more frequently than African Americans (p < .001). Logistic regression reveals that social worker and physician intervention, not patient-specific variables, are the primary predictors of AMD incidence. Policy makers may need to consider the realities of hospital care, especially in emergency settings, and be more specific in the steps of implementation of the policy in the evenings, weekends, and holidays. True adherence to policy implementation may require hospital administrators to increase staff and educational efforts so that the concept of AMD communication and documentation is completely explained to all staff and patients. Policy should include an electronic record reminder that is renewed every 3 years and provisions for accommodating patients who arrive on weekends and holidays, with special awareness of the particular communication needs of minority groups. The study conclusions are that further inquiry is needed to understand these policy nuances to enable the Veterans Affairs Administration to

  10. Medical waste management in Turkey: A case study of Istanbul.

    PubMed

    Birpinar, Mehmet Emin; Bilgili, Mehmet Sinan; Erdoğan, Tuğba

    2009-01-01

    The objective of this study was to analyze the present status of medical waste management in the light of the Medical Waste Control Regulation (MWCR) in Istanbul, the largest city in Turkey. About 17% of the hospitals, 20% of bed capacity, and 54% of private hospitals in Turkey are located in Istanbul. The first regulation about medical waste management in Turkey was published in 1993, and as a candidate state, it was changed in 2005 in accordance with EU Environmental Directives. In this work, a survey of 14 questions about the amount, collection, and temporary storage of medical wastes was applied to 192 hospitals in Istanbul through face-to-face interviews. It was found that the estimated quantity of medical waste from the hospitals is about 22tons/day and the average generation rate is 0.63kg/bed-day. Recyclable materials are collected separately at a rate of 83%. Separate collection of different types of wastes is consistently practiced, but 25% of the hospitals still use inappropriate containers for medical waste collection. Almost 77% of the hospitals use appropriate equipment for the medical waste collection personnel. The percentage of the hospitals that have temporary storage depots is 63%. Medical waste management in Istanbul is carried out by applying the MWCR.

  11. [Main types of activity of specialists of medical and preventive profile in military hospitals].

    PubMed

    Akimkin, V G; Azarov, I I; Volynkov, I O; Bobylev, V A

    2015-09-01

    Infection prevention in medical organizations is an essential task to ensure quality of medical care and create a safe environment for patients and medical staff. The main task of a specialist of medical and preventive profile in the hospital is to maintain sanitary and epidemiological safety and control fulfillment of a complex of preventive measures. To achieve these goals specialists monitor epidemiological and microbiological fulfilment of the implementation and effectiveness of preventive measures, which allow to except infection entry to the hospital and possible carrying out beyond the hospital, occurrence and spread of disease. An obligatory activity of the specialist of medical and preventive profile in the hospital is a scientific and methodical work. The authors propose adoption of preventive structural subdivisions to the state largest diversified military hospitals.

  12. Cost of Hospitalization for Foodborne Diarrhea: A Case Study from Vietnam

    PubMed Central

    Tran, Tuan Anh; Ha, Anh Duc; Nguyen, Viet Hung

    2015-01-01

    Vietnam is undergoing a rapid social and economic developments resulting in speedy urbanization, changes in methods for animal production, food marketing systems, and food consumption habits. These changes will have major impacts on human exposures to food poisoning. The present case study aimed to estimate hospitalization costs of foodborne diarrhea cases in selected health facilities in Vietnam. This is a facility-based cost-of-illness study conducted in seven health facilities in Northern Vietnam. All suspect cases of foodborne diarrhea, as diagnosed by doctors, who admitted to the studied health facilities during June-August, 2013 were selected. Costs associated with hospitalization for foodborne diseases were estimated from societal perspective using retrospective approach. We included direct and indirect costs of hospitalization of foodborne diarrhea cases. During the study period, 87 foodborne diarrhea cases were included. On average, the costs per treatment episode and per hospitalization day for foodborne diarrhea case were US$ 106.9 and US$ 33.6 respectively. Indirect cost (costs of times to patient, their relatives due to the patient's illness) made up the largest share (51.3%). Direct medical costs accounted for 33.8%; direct non-medical costs (patient and their relatives) represented 14.9%. Cost levels and compositions varied by level of health facilities. More attentions should be paid on prevention, control of foodborne diarrhea cases in Vietnam. Ensuring safety of food depends on efforts of everyone involved in food chain continuum, from production, processing, and transport to consumption. PMID:26617452

  13. Cost of Hospitalization for Foodborne Diarrhea: A Case Study from Vietnam.

    PubMed

    Hoang, Van Minh; Tran, Tuan Anh; Ha, Anh Duc; Nguyen, Viet Hung

    2015-11-01

    Vietnam is undergoing a rapid social and economic developments resulting in speedy urbanization, changes in methods for animal production, food marketing systems, and food consumption habits. These changes will have major impacts on human exposures to food poisoning. The present case study aimed to estimate hospitalization costs of foodborne diarrhea cases in selected health facilities in Vietnam. This is a facility-based cost-of-illness study conducted in seven health facilities in Northern Vietnam. All suspect cases of foodborne diarrhea, as diagnosed by doctors, who admitted to the studied health facilities during June-August, 2013 were selected. Costs associated with hospitalization for foodborne diseases were estimated from societal perspective using retrospective approach. We included direct and indirect costs of hospitalization of foodborne diarrhea cases. During the study period, 87 foodborne diarrhea cases were included. On average, the costs per treatment episode and per hospitalization day for foodborne diarrhea case were US$ 106.9 and US$ 33.6 respectively. Indirect cost (costs of times to patient, their relatives due to the patient's illness) made up the largest share (51.3%). Direct medical costs accounted for 33.8%; direct non-medical costs (patient and their relatives) represented 14.9%. Cost levels and compositions varied by level of health facilities. More attentions should be paid on prevention, control of foodborne diarrhea cases in Vietnam. Ensuring safety of food depends on efforts of everyone involved in food chain continuum, from production, processing, and transport to consumption.

  14. Rural hospital ownership: medical service provision, market mix, and spillover effects.

    PubMed

    Horwitz, Jill R; Nichols, Austin

    2011-10-01

    To test whether nonprofit, for-profit, or government hospital ownership affects medical service provision in rural hospital markets, either directly or through the spillover effects of ownership mix. Data are from the American Hospital Association, U.S. Census, CMS Healthcare Cost Report Information System and Prospective Payment System Minimum Data File, and primary data collection for geographic coordinates. The sample includes all nonfederal, general medical, and surgical hospitals located outside of metropolitan statistical areas and within the continental United States from 1988 to 2005. We estimate multivariate regression models to examine the effects of (1) hospital ownership and (2) hospital ownership mix within rural hospital markets on profitable versus unprofitable medical service offerings. Rural nonprofit hospitals are more likely than for-profit hospitals to offer unprofitable services, many of which are underprovided services. Nonprofits respond less than for-profits to changes in service profitability. Nonprofits with more for-profit competitors offer more profitable services and fewer unprofitable services than those with fewer for-profit competitors. Rural hospital ownership affects medical service provision at the hospital and market levels. Nonprofit hospital regulation should reflect both the direct and spillover effects of ownership. © Health Research and Educational Trust.

  15. 78 FR 16614 - Medicare Program; Medicare Hospital Insurance (Part A) and Medicare Supplementary Medical...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-18

    ... Medicare Program; Medicare Hospital Insurance (Part A) and Medicare Supplementary Medical Insurance (Part B... following the denial of a Part A inpatient hospital claim by a Medicare review contractor on the basis that... Inpatient Billing in Hospitals,'' to propose a permanent policy that would apply on a prospective basis...

  16. Hazards of Hospitalization: Hospitalists and Geriatricians Educating Medical Students about Delirium and Falls in Geriatric Inpatients

    ERIC Educational Resources Information Center

    Lang, Valerie J.; Clark, Nancy S.; Medina-Walpole, Annette; McCann, Robert

    2008-01-01

    Geriatric patients are at increased risk for complications from delirium or falls during hospitalization. Medical education, however, generally places little emphasis on the hazards of hospitalization for older inpatients. Geriatricians conducted a faculty development workshop for hospitalists about the hazards of hospitalization for geriatric…

  17. Rural Hospital Ownership: Medical Service Provision, Market Mix, and Spillover Effects

    PubMed Central

    Horwitz, Jill R; Nichols, Austin

    2011-01-01

    Objective To test whether nonprofit, for-profit, or government hospital ownership affects medical service provision in rural hospital markets, either directly or through the spillover effects of ownership mix. Data Sources/Study Setting Data are from the American Hospital Association, U.S. Census, CMS Healthcare Cost Report Information System and Prospective Payment System Minimum Data File, and primary data collection for geographic coordinates. The sample includes all nonfederal, general medical, and surgical hospitals located outside of metropolitan statistical areas and within the continental United States from 1988 to 2005. Study Design We estimate multivariate regression models to examine the effects of (1) hospital ownership and (2) hospital ownership mix within rural hospital markets on profitable versus unprofitable medical service offerings. Principal Findings Rural nonprofit hospitals are more likely than for-profit hospitals to offer unprofitable services, many of which are underprovided services. Nonprofits respond less than for-profits to changes in service profitability. Nonprofits with more for-profit competitors offer more profitable services and fewer unprofitable services than those with fewer for-profit competitors. Conclusions Rural hospital ownership affects medical service provision at the hospital and market levels. Nonprofit hospital regulation should reflect both the direct and spillover effects of ownership. PMID:21639860

  18. Hazards of Hospitalization: Hospitalists and Geriatricians Educating Medical Students about Delirium and Falls in Geriatric Inpatients

    ERIC Educational Resources Information Center

    Lang, Valerie J.; Clark, Nancy S.; Medina-Walpole, Annette; McCann, Robert

    2008-01-01

    Geriatric patients are at increased risk for complications from delirium or falls during hospitalization. Medical education, however, generally places little emphasis on the hazards of hospitalization for older inpatients. Geriatricians conducted a faculty development workshop for hospitalists about the hazards of hospitalization for geriatric…

  19. General Hospital and Personal Use Devices: Renaming of Pediatric Hospital Bed Classification and Designation of Special Controls for Pediatric Medical Crib; Classification of Medical Bassinet. Final rule.

    PubMed

    2016-12-19

    The Food and Drug Administration (FDA) is issuing a final rule to rename pediatric hospital beds as pediatric medical cribs and establish special controls for these devices. FDA is also establishing a separate classification regulation for medical bassinets, previously under the pediatric hospital bed classification regulation, as a class II (special controls) device. In addition, this rule continues to allow both devices to be exempt from premarket notification and use of the device in traditional health care settings and permits prescription use of pediatric medical cribs and bassinets outside of traditional health care settings.

  20. Hospitalizations of Adults with Intellectual Disability in Academic Medical Centers

    ERIC Educational Resources Information Center

    Ailey, Sarah H.; Johnson, Tricia; Fogg, Louis; Friese, Tanya R.

    2014-01-01

    Individuals with intellectual disability (ID) represent a small but important group of hospitalized patients who often have complex health care needs. Individuals with ID experience high rates of hospitalization for ambulatory-sensitive conditions and high rates of hospitalizations in general, even when in formal community care systems; however,…

  1. Discounting medical malpractice claim reserves for self-insured hospitals.

    PubMed

    Frese, Richard; Kitchen, Patrick

    2011-01-01

    The hospital CFO often works with the hospital's actuary and external auditor to calculate the reserves recorded in financial statements. Hospital management, usually the CFO, needs to decide the discount rate that is most appropriate. A formal policy addressing the rationale for discounting and the rationale for selecting the discount rate can be helpful to the CFO, actuary, and external auditor.

  2. Hospitalizations of Adults with Intellectual Disability in Academic Medical Centers

    ERIC Educational Resources Information Center

    Ailey, Sarah H.; Johnson, Tricia; Fogg, Louis; Friese, Tanya R.

    2014-01-01

    Individuals with intellectual disability (ID) represent a small but important group of hospitalized patients who often have complex health care needs. Individuals with ID experience high rates of hospitalization for ambulatory-sensitive conditions and high rates of hospitalizations in general, even when in formal community care systems; however,…

  3. A first evaluation of a pedagogical network for medical students at the University Hospital of Rennes.

    PubMed

    Fresnel, A; Jarno, P; Burgun, A; Delamarre, D; Denier, P; Cleret, M; Courtin, C; Seka, L P; Pouliquen, B; Cléran, L; Riou, C; Leduff, F; Lesaux, H; Duvauferrier, R; Le Beux, P

    1998-01-01

    A pedagogical network has been developed at University Hospital of Rennes from 1996. The challenge is to give medical information and informatics tools to all medical students in the clinical wards of the University Hospital. At first, nine wards were connected to the medical school server which is linked to the Internet. Client software electronic mail and WWW Netscape on Macintosh computers. Sever software is set up on Unix SUN providing a local homepage with selected pedagogical resources. These documents are stored in a DBMS database ORACLE and queries can be provided by specialty, authors or disease. The students can access a set of interactive teaching programs or electronic textbooks and can explore the Internet through the library information system and search engines. The teachers can send URL and indexation of pedagogical documents and can produce clinical cases: the database updating will be done by the users. This experience of using Web tools generated enthusiasm when we first introduced it to students. The evaluation shows that if the students can use this training early on, they will adapt the resources of the Internet to their own needs.

  4. Case for tort reform in medical malpractice.

    PubMed

    DeLuke, Dean M

    2006-05-01

    Under tort law, injured parties have the basic right to seek indemnity for wrongful injury, including injury from medical malpractice. Unfortunately, the present system is associated with many undesirable secondary effects, including problems of patient access to care, excessive testing or overtreatment, and undertreatment due to doctors' fear of malpractice. Nationwide, there are innumerable cases of doctors abandoning obstetrical or other high risk practices, or migrating away from states with less friendly tort laws. The California MICRA legislation of 1976 is often cited as a model for tort reform, but even this model legislation may be insufficient to restore a beleaguered trust between medical providers and their patients. Several key research studies suggest that the jury system fails to fairly and reliably compensate injured patients, and fails to deter or discipline errant doctors. To adequately meet the common needs of patients and health care providers, there must be an appropriate emphasis on aggressive risk management, quality improvement, patient safety, professional oversight, and responsible insurance underwriting. Moreover, there must be a systemic improvement of the current tort system as it pertains to medical malpractice. Although incremental reforms at the state level are slowly occurring and should certainly be supported, a greater reward may ultimately stem from more radical restructuring to a system of medical tribunals.

  5. A longitudinal study of medication nonadherence and hospitalization risk in schizophrenia.

    PubMed

    Law, Michael R; Soumerai, Stephen B; Ross-Degnan, Dennis; Adams, Alyce S

    2008-01-01

    Previous cross-sectional studies have suggested an association between medication nonadherence and hospitalization for individuals with schizophrenia. However, such analyses typically measure adherence averaged over long time periods. We investigated the temporal relationship between nonadherence and hospitalization risk using a daily measure of medication availability. Our observational cohort included 1191 patients with schizophrenia (ICD-9 criteria) enrolled in Maine and New Hampshire Medicaid programs who initiated atypical antipsychotic therapy between January 1, 2001, and December 31, 2003. Pharmacy claims were used to define days with gaps in medication availability. We tested the association of gaps in medication availability with all-cause, mental health, and schizophrenia-specific hospitalization using a Cox regression model. Compared to individuals with available medication, individuals in the first 10 days following a missed prescription refill had a hazard ratio of 1.54 (95% CI = 1.02 to 2.32) for mental health hospitalization and 1.77 (95% CI = 1.16 to 2.71) for schizophrenia hospitalization. Similarly, medication gaps of more than 30 days were associated with 50% increased hazard for all 3 hospitalization outcomes. Switching and augmenting therapy, previous hospitalization, and clinical severity measures were also associated with substantially increased hazard of hospitalization. Our findings indicate that patients may be at significantly increased risk for hospitalization as early as the first 10 days following a missed medication refill. Patients who switched or augmented medications or were previously hospitalized also demonstrated increased hospitalization risk. Clinicians and Medicaid programs should consider using pharmacy claims to monitor medication use and target adherence interventions to reduce relapses in this vulnerable population.

  6. Medical waste management in China: a case study of Nanjing.

    PubMed

    Yong, Zhang; Gang, Xiao; Guanxing, Wang; Tao, Zhou; Dawei, Jiang

    2009-04-01

    Medical waste management is of great importance due to its infectious and hazardous nature that can cause undesirable effects on humans and the environment. The objective of this study was to analyze and evaluate the present status of medical waste management in the light of medical waste control regulations in Nanjing. A comprehensive inspection survey was conducted for 15 hospitals, 3 disposal companies and 200 patients. Field visits and a questionnaire survey method were implemented to collect information regarding different medical waste management aspects, including medical waste generation, segregation and collection, storage, training and education, transportation, disposal, and public awareness. The results indicated that the medical waste generation rate ranges from 0.5 to 0.8 kg/bed day with a weighted average of 0.68 kg/bed day. The segregated collection of various types of medical waste has been conducted in 73% of the hospitals, but 20% of the hospitals still use unqualified staff for medical waste collection, and 93.3% of the hospitals have temporary storage areas. Additionally, 93.3% of the hospitals have provided training for staff; however, only 20% of the hospitals have ongoing training and education. It was found that the centralized disposal system has been constructed based on incineration technology, and the disposal cost of medical waste is about 580 US$/ton. The results also suggested that there is not sufficient public understanding of medical waste management, and 77% of respondents think medical waste management is an important factor in selecting hospital services. The problematic areas of medical waste management in Nanjing are addressed by proposing some recommendations that will ensure that potential health and environmental risks of medical waste are minimized.

  7. Interventions for reducing medication errors in children in hospital.

    PubMed

    Maaskant, Jolanda M; Vermeulen, Hester; Apampa, Bugewa; Fernando, Bernard; Ghaleb, Maisoon A; Neubert, Antje; Thayyil, Sudhin; Soe, Aung

    2015-03-10

    checklist. We evaluated the risk of bias of included studies and used the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach to assess the quality of the body of evidence. We described results narratively and presented them using GRADE tables. We included seven studies describing five different interventions: participation of a clinical pharmacist in a clinical team (n = 2), introduction of a computerised physician order entry system (n = 2), implementation of a barcode medication administration system (n = 1), use of a structured prescribing form (n = 1) and implementation of a check and control checklist in combination with feedback (n = 1).Clinical and methodological heterogeneity between studies precluded meta-analyses. Although some interventions described in this review show a decrease in MEs, the results are not consistent, and none of the studies resulted in a significant reduction in patient harm. Based on the GRADE approach, the overall quality and strengfh of the evidence are low. Current evidence on effective interventions to prevent MEs in a paediatric population in hospital is limited. Comparative studies with robust study designs are needed to investigate interventions including components that focus on specific paediatric safety issues.

  8. The future of medical schools and teaching hospitals in the era of managed care.

    PubMed

    Pardes, H

    1997-02-01

    At the 125 U.S. medical schools and their affiliated teaching hospitals, most of the nation's basic and clinical research advances are made, and these translate into topflight medical care and great reductions in health care costs (e.g., $30 billion a year for polio). But these medical schools and teaching hospitals and their capacities to provide critical education and research are threatened by escalating erosion of their infrastructure, the declining academic workforce, the diminishing of quality and access as a result of growing marketplace forces, and shrinking funds. The author provides details about the forces threatening academic medical centers (i.e., medical schools and their affiliated teaching hospitals) and then presents a variety of strategies that individual academic medical centers can carry out to more efficiently use their resources. But sufficient resources ae still needed if centers are to function as they should. What is to save them? The author indicates that centers should not overly depend on managed care, the pharmaceutical industry, or foundations to provide the necessary support, and that centers' internal strategies can go only so far. He proposes that the importance of centers and the dangers they face must be communicated convincingly to the nation's citizens, business leaders, government representatives, and purchasers of health care. The message must be repeated frequently so it will sink in, and must be given in terms that are relevant to individuals and their families. He also advises that certain types of partnerships may be helpful. But most critical is the need to persuade the government to mandate separate revenue streams for research, education, and care for the underserved. As hard as this will be to achieve, there are many allies of academic medicine, from the president to numerous legislators; the author discusses what they have said and done to help. He concludes by urging everyone in academic medicine to do their parts to

  9. Effects of hospital accreditation on medical students: a national qualitative study in Taiwan.

    PubMed

    Ho, Ming-Jung; Chang, Heng-Hao; Chiu, Yu-Ting; Norris, Jessie L

    2014-11-01

    Hospital accreditation has become a global trend for improving the quality of health care services. In Taiwan, nearly all hospitals are accredited. However, there is a paucity of literature on the effects of hospital accreditation on medical students and the universal applicability of hospital accreditation as developed in the West. The purpose of this study was to investigate the effects of hospital accreditation on medical students in Taiwan. From 2010 to 2012, the authors conducted semistructured interviews with 34 senior, clinical year students at 11 different medical schools in Taiwan. Following a grounded theory approach, the authors transcribed and analyzed the transcripts concurrently with data collection in order to identify emergent themes. Aside from the intended positive effects of hospital accreditation, this study revealed several unintended impacts on medical students, including decreased clinical learning opportunities, increased trivial workload, and violation of professional integrity. Taiwanese students expressed doubt and frustration concerning the value of hospital accreditation and reflected on the cultural and systemic context in which accreditation takes place. Their commentary addressed the challenges associated with the globalization of hospital accreditation processes. This study suggests that, beyond the improvement of patient safety and quality assurance, medical educators must recognize the unintended negative effects of hospital accreditation on medical education and take into account differences in culture and health care systems amid the globalization of medicine.

  10. Implementation of a pharmacy automation system (robotics) to ensure medication safety at Norwalk hospital.

    PubMed

    Bepko, Robert J; Moore, John R; Coleman, John R

    2009-01-01

    This article reports an intervention to improve the quality and safety of hospital patient care by introducing the use of pharmacy robotics into the medication distribution process. Medication safety is vitally important. The integration of pharmacy robotics with computerized practitioner order entry and bedside medication bar coding produces a significant reduction in medication errors. The creation of a safe medication-from initial ordering to bedside administration-provides enormous benefits to patients, to health care providers, and to the organization as well.

  11. [Forensic medical examination of a medical malpractice case as a form of situational expertise].

    PubMed

    Leonov, S V; Kozlov, S V

    2011-01-01

    The authors propose to divide the process of forensic medical examination of a medical malpractice case into several stages and substantiate the possibility of their realization as a form of situational forensic medical expertise.

  12. Additional funding mechanisms for Public Hospitals in Greece: the case of Chania Mental Health Hospital

    PubMed Central

    2010-01-01

    Objectives To investigate whether the long term lease of public hospital owned land could be an additional financing mechanism for Greek public (mental) health hospitals. Methods We performed a financial analysis of the official 2008 data of a case - study hospital (Mental Health Hospital of Chania). We used a capital budgeting approach to investigate whether value is created for the public hospital by engaging its assets in a project for the development of a private renal dialysis Unit. Results The development of the private unit in hospital owned land is a good investment decision, as it generates high project Net Present Value and Internal Rate of Return. When the project commences generating operating cash flows, nearly €400.000 will be paid annually to the Mental Health Hospital of Chania as rent, thereby gradually decreasing the annual deficit of the hospital. Conclusions Revenue generated from the long term lease of public hospital land is crucial to gradually eliminate hospital deficit. The Ministry of Health should encourage similar forms of Public Private Partnerships in order to ensure the sustainability of public (mental) hospitals. PMID:21067580

  13. Medication Errors Among Geriatrics at the Outpatient Pharmacy in a Teaching Hospital in Kelantan

    PubMed Central

    Abdullah, Dellemin Che; Ibrahim, Noor Shufiza; Ibrahim, Mohamed Izham Mohamed

    2004-01-01

    The main aim of this study was to determine the medication errors among geriatrics at the outpatient pharmacy in a teaching hospital in Kelantan and the strategies to minimize the prevalence. A retrospective study was conducted that involved screening of prescription for a one-month period (March 2001). Only 15.35% (1601 prescription) of a total 10,429 prescriptions were for geriatrics. The prescriptions that were found to have medication errors was 403. Therefore, the prevalence of medication errors per day was approximately 20 cases. Generally, the errors between both genders were found to be comparable and to be the highest for Malays and at the age of 60–64 years old. Administrative errors was recorded to be the highest which included patient’s particulars and validity of the prescriptions (70.22%) and drugs that available in HUSM (16.13%). Whereas the total of prescribing errors were low. Under prescribing errors were pharmaceutical error (0.99%) and clinical error (8.68%). Sixteen cases or 3.98% had more than 1 error. The highest prevalence went to geriatrics who received more than nine drugs (32.16%), geriatrics with more than 3 clinical diagnosis (10.06%), geriatrics who visited specialist clinics (37.52%) and treated by the specialists (31.07%). The estimated cost for the 403 medication errors in March was RM9,327 or RM301 per day that included the cost of drugs and humanistic cost. The projected cost of medication errors per year was RM 111,924. In conclusion, it is very clear that the role of pharmacist is very great in preventing and minimizing the medication errors beside the needs of correct prescription writing and other strategies by all of the heath care components. PMID:22973127

  14. Hospital ownership and medical services: market mix, spillover effects, and nonprofit objectives.

    PubMed

    Horwitz, Jill R; Nichols, Austin

    2009-09-01

    Hospitals operate in markets with varied demographic, competitive, and ownership characteristics, yet research on ownership tends to examine hospitals in isolation. Here we examine three hospital ownership types -- nonprofit, for-profit, and government -- and their spillover effects. We estimate the effects of for-profit market share in two ways, on the provision of medical services and on operating margins at the three types of hospitals. We find that nonprofit hospitals' medical service provision systematically varies by market mix. We find no significant effect of market mix on the operating margins of nonprofit hospitals, but find that for-profit hospitals have higher margins in markets with more for-profits. These results fit best with theories in which hospitals maximize their own output.

  15. Despite regulatory changes, hospitals cautious in helping physicians purchase electronic medical records.

    PubMed

    Grossman, Joy M; Cohen, Genna

    2008-09-01

    While hospitals are evaluating strategies to help physicians purchase electronic medical records (EMRs) following recent federal regulatory changes, they are proceeding cautiously, according to findings from the Center for Studying Health System Change's (HSC) 2007 site visits to 12 nationally representative metropolitan communities. Hospital strategies to aid physician EMR adoption include offering direct financial subsidies, extending the hospital's ambulatory EMR vendor discounts and providing technical support. Two key factors driving hospital interest in supporting physician EMR adoption are improving the quality and efficiency of care and aligning physicians more closely with the hospital. A few hospitals have begun small-scale, phased rollouts of subsidized EMRs, but the burden of other hospital information technology projects, budget limitations and lack of physician interest are among the factors impeding hospital action. While it is too early to assess whether the regulatory changes will spur greater physician EMR adoption, the outcome will depend both on hospitals' willingness to provide support and physicians' acceptance of hospital assistance.

  16. Medical Record Clerk Training Program, Course of Study; Student Manual: For Medical Record Personnel in Small Rural Hospitals in Colorado.

    ERIC Educational Resources Information Center

    Community Health Service (DHEW/PHS), Arlington, VA. Div. of Health Resources.

    The manual provides major topics, objectives, activities and, procedures, references and materials, and assignments for the training program. The topics covered are hospital organization and community role, organization and management of a medical records department, international classification of diseases and operations, medical terminology,…

  17. Derivation and confirmation of scales measuring medical directors' attitudes about the hospitalization of nursing home residents.

    PubMed

    Marcantonio, Edward R; O'Malley, A James; Murkofsky, Rachel L; Caudry, Daryl J; Buchanan, Joan L

    2006-12-01

    To derive and confirm scales measuring medical director's attitudes about hospitalization of nursing home residents. The authors surveyed nursing facility medical directors about the necessity of hospitalizing residents for eight clinical conditions and compared the ratings to those obtained from an expert panel to derive a relative hospitalization score. They also asked about factors that might influence hospitalization decisions. They performed a factor analysis to derive scales that measure attitudinal determinants of hospitalization and used the relative hospitalization score to confirm the scales. The survey had a 79% response rate. The relative hospitalization score demonstrated that medical directors were slightly less likely to recommend hospitalization than expert panel physicians. Factor analyses yielded 10 scales focusing on nursing home functioning, economics, resident specific considerations, and physician attitudes. Eight of the 10 scales had significant bivariable associations with the relative hospitalization score, and 6 had significant multivariable associations. Medical directors identify multiple determinants of hospitalization for nursing facility residents across several domains. Hospitalization decisions for nursing facility residents are complex and involve clinical and nonclinical factors.

  18. Collaboration of hospital case managers and home care liaisons when transitioning patients.

    PubMed

    Kelly, Margaret M; Penney, Erika D

    2011-01-01

    Hospital case managers frequently collaborate with home care liaisons when coordinating special discharge plans. This article focuses on the collaborative relationship between the hospital case manager and on-site liaison whose primary role centers around care coordination and patient teaching. Ineffective collaboration between hospital case managers and these clinical on-site liaisons can lead to serious lapses in care and services for patients, families, and the health care team when transitioning from hospital to home care. In a review of literature, little detail was found about the collaborative practice between hospital case managers and home care liaisons. This article discusses how collegiality, collaboration, and role clarification between hospital case managers and on-site home care liaisons can improve coordination of care and services for patients and their families in the transition from hospital to home care. Included is a set of guidelines developed by case managers at a major metropolitan acute care hospital to inform and improve their practice with home care liaisons. The authors are nursing case managers who practice in a major metropolitan teaching hospital. They met by telephone and in person with case managers from 3 metropolitan medical centers as well as on-site liaisons from 2 skilled nursing facilities and 5 home care agencies to develop practice recommendations for their department regarding work with home care liaisons. Conversations between hospital case managers and on-site home care liaisons revealed that all had experiences in which suboptimal collaboration negatively impacted home care coordination for patients and their families. Furthermore, outcomes in similar patient scenarios varied widely based on the individual practices of the case managers and liaisons involved in discharge coordination. Multiple issues were discussed, including blurred role and responsibility delineations, variations in communication styles and practices

  19. Reasons for Discharge against Medical Advice: A Case Study of Emergency Departments in Iran

    PubMed Central

    Noohi, Kaveh; Komsari, Samaneh; Nakhaee, Nouzar; Yazdi Feyzabadi, Vahid

    2013-01-01

    Background: Incomplete hospitalization is the cause of disease relapse, readmission, and increase in medical costs. Discharge Against Medical Advice (DAMA) in emergency department (ED) is critical for hospitals. This paper aims to explore the underlying reasons behind DAMA in ED of four teaching hospitals in Kerman, Iran. Methods: This was a cross-sectional study in which the samples were drawn from the patients who chose to leave against medical advice from the ED of teaching hospitals in Kerman from February to March 2011. The sampling was based on census. Data were gathered by a self-constructed questionnaire. The reasons for DAMA were divided into three parts: reasons related to patient, medical staff, and hospital environment. The questionnaire was filled out by a face-to-face interview with patient or a reliable companion. Results: There were 121 cases (5.6%) of DAMA out of the total admissions. The main reason of AMA discharges was related to patient factors in 43.9% of cases, while two other factors (i.e., hospital environment and medical staff) constituded 41.2% and 35.2% of cases, respectively. The majority of patients 65.9% (80 cases) were either uninformed or less informed of the entailing side effects and outcomes of their decision to DAMA. Conclusion: In comparison to studies conducted in other countries, the rate of DAMA is markedly higher in Iran. The results revealed that patients awareness of the consequences of their decisions is evidently inadequate. The study suggests a number of recommendations. These include, increasing patient awareness of the potential side effects of DAMA and creating the necessary culture for this, improving hospital facilities, and a more careful supervision of medical staff performance. PMID:24596853

  20. Job stress and burnout in hospital employees: comparisons of different medical professions in a regional hospital in Taiwan

    PubMed Central

    Chou, Li-Ping; Li, Chung-Yi; Hu, Susan C

    2014-01-01

    Objectives To explore the prevalence and associated factors of burnout among five different medical professions in a regional teaching hospital. Design Cross-sectional study. Setting Hospital-based survey. Participants A total of 1329 medical professionals were recruited in a regional hospital with a response rate of 89%. These voluntary participants included 101 physicians, 68 physician assistants, 570 nurses, 216 medical technicians and 374 administrative staff. Primary and secondary outcome measures Demographic data included gender, age, level of education and marital status, and work situations, such as position, work hours and work shifts, were obtained from an electronic questionnaire. Job strain and burnout were measured by two validated questionnaires, the Chinese version of the Job Content Questionnaire and the Copenhagen Burnout Inventory. Results Among the five medical professions, the prevalence of high work-related burnout from highest to lowest was nurses (66%), physician assistants (61.8%), physicians (38.6%), administrative staff (36.1%) and medical technicians (31.9%), respectively. Hierarchical regression analysis indicated that job strain, overcommitment and low social support explained the most variance (32.6%) of burnout. Conclusions Physician assistant is an emerging high burnout group; its severity is similar to that of nurses and far more than that of physicians, administrative staff and medical technicians. These findings may contribute to the development of feasible strategies to reduce the stress which results in the burnout currently plaguing most hospitals in Taiwan. PMID:24568961

  1. Job stress and burnout in hospital employees: comparisons of different medical professions in a regional hospital in Taiwan.

    PubMed

    Chou, Li-Ping; Li, Chung-Yi; Hu, Susan C

    2014-02-25

    To explore the prevalence and associated factors of burnout among five different medical professions in a regional teaching hospital. Cross-sectional study. Hospital-based survey. A total of 1329 medical professionals were recruited in a regional hospital with a response rate of 89%. These voluntary participants included 101 physicians, 68 physician assistants, 570 nurses, 216 medical technicians and 374 administrative staff. Demographic data included gender, age, level of education and marital status, and work situations, such as position, work hours and work shifts, were obtained from an electronic questionnaire. Job strain and burnout were measured by two validated questionnaires, the Chinese version of the Job Content Questionnaire and the Copenhagen Burnout Inventory. Among the five medical professions, the prevalence of high work-related burnout from highest to lowest was nurses (66%), physician assistants (61.8%), physicians (38.6%), administrative staff (36.1%) and medical technicians (31.9%), respectively. Hierarchical regression analysis indicated that job strain, overcommitment and low social support explained the most variance (32.6%) of burnout. Physician assistant is an emerging high burnout group; its severity is similar to that of nurses and far more than that of physicians, administrative staff and medical technicians. These findings may contribute to the development of feasible strategies to reduce the stress which results in the burnout currently plaguing most hospitals in Taiwan.

  2. The Impact of Public Hospital Closure on Medical and Residency Education: Implications and Recommendations

    PubMed Central

    Walker, Kara Odom; Calmes, Daphne; Hanna, Nancy; Baker, Richard

    2010-01-01

    Background Challenges around safety-net hospital closure have impacted medical student and resident exposure to urban public healthcare sites that may influence their future practice choices. Objective To assess the impact of the closure of a public safety-net teaching hospital for the clinical medical education of Charles Drew University medical students and residents. Method Retrospective cohort study of medical students’ and residents’ and clinical placement into safety-net experiences after the closure of the primary teaching hospital. Results The hospital closure impacted both medical student and residency training experiences. Only 71% (17/24) of medical student rotations and 13% (23/180) of residents were maintained at public safety-net clinical sittings. The closure of the public safety-net hospital resulted in the loss of 36% of residency training spots sponsored by historically black medical schools in the United States and an even larger negative impact on the number of physicians training in underserved urban areas of Los Angeles County. Conclusion While the medical educational program changes undertaken in the wake of hospital closure have negatively affected the immediate clinical educational experiences of medical students and residents, it remains to be seen whether the training site location changes will alter their long-term preferences in specialty choice and practice location. PMID:19110905

  3. Systems factors in the reporting of serious medication errors in hospitals.

    PubMed

    Crawford, Stephanie Y; Cohen, Michael R; Tafesse, Eskinder

    2003-12-01

    Underreporting of medication errors poses a threat to quality improvement initiatives. Hospital risk management programs encourage medication error reporting for effective management of systems failures. This study involved a survey of 156 medical-surgical hospitals in the United States to evaluate systems factors associated with the reporting of serious medication errors. Prior to controlling for bed size, a multivariate logistic regression model showed increased reporting of medication errors in hospitals with 24-h pharmacy services, presumably because of better error reporting systems. When number of occupied beds was included, the final model demonstrated bed size to be the only statistically significant factor. Increased reporting rates for serious medication errors warrant further evaluation, but higher error reporting may paradoxically indicate improved error surveillance. Results suggest that increased availability of pharmacist services results in opportunities for more diligent systematic efforts in detecting and reporting medication errors, which should lead to improved patient safety.

  4. Salmonella enterica serovar Oranienburg outbreak in a veterinary medical teaching hospital with evidence of nosocomial and on-farm transmission.

    PubMed

    Cummings, Kevin J; Rodriguez-Rivera, Lorraine D; Mitchell, Katharyn J; Hoelzer, Karin; Wiedmann, Martin; McDonough, Patrick L; Altier, Craig; Warnick, Lorin D; Perkins, Gillian A

    2014-07-01

    Nosocomial salmonellosis continues to pose an important threat to veterinary medical teaching hospitals. The objectives of this study were to describe an outbreak of salmonellosis caused by Salmonella enterica serovar Oranienburg within our hospital and to highlight its unique features, which can be used to help mitigate or prevent nosocomial outbreaks in the future. We retrospectively analyzed data from patients that were fecal culture-positive for Salmonella Oranienburg between January 1, 2006, and June 1, 2011, including historical, clinical, and pulsed-field gel electrophoresis (PFGE) data. Salmonella Oranienburg was identified in 20 horses, five alpacas, and three cows during this time frame, with dates of admission spanning the period from August, 2006, through January, 2008. We consider most of these patients to have become infected through either nosocomial or on-farm transmission, as evidenced by molecular subtyping results and supportive epidemiologic data. Interpretation of PFGE results in this outbreak was challenging because of the identification of several closely related Salmonella Oranienburg subtypes. Furthermore, a high percentage of cases were fecal culture-positive for Salmonella Oranienburg within 24 h of admission. These patients initially appeared to represent new introductions of Salmonella into the hospital, but closer inspection of their medical records revealed epidemiologic links to the hospital following the index case. Cessation of this outbreak was observed following efforts to further heighten biosecurity efforts, with no known cases or positive environmental samples after January, 2008. This study demonstrates that a Salmonella-positive culture result within 24 h of admission does not exclude the hospital as the source of infection, and it underscores the important role played by veterinary medical teaching hospitals as nodes of Salmonella infection that can promote transmission outside of the hospital setting.

  5. Seriously clowning: Medical clowning interaction with children undergoing invasive examinations in hospitals.

    PubMed

    Tener, Dafna; Ofir, Shoshi; Lev-Wiesel, Rachel; Franco, Nessia L; On, Avi

    2016-04-01

    This qualitative study examined the subjective experience of children undergoing an invasive examination in the hospital when accompanied by a medical clown. In-depth semi-structured interviews were conducted with nine such children and nine of their accompanying parents. The children were patients in two outpatient departments (Pediatric Gastroenterology and a Center for the Sexually Abused) in a hospital in Israel. Interviews were coded thematically using an Atlas.ti software program. Analysis of the interviews indicated that the intervention of the clown positively changed the children's perceptions of the hospital, of experiencing the examination, and of their life narrative. Medical clowns thus appear to be a central, meaningful, and therapeutic source for children undergoing invasive examinations in hospital, as well as for their parents. Therefore, it may be advisable to incorporate medical clowns as an integral part of medical teams performing invasive procedures and to include the clowns in all stages of the hospital visit.

  6. Population versus hospital controls for case-control studies on cancers in Chinese hospitals.

    PubMed

    Li, Lin; Zhang, Min; Holman, D'Arcy

    2011-12-15

    Correct control selection is crucial to the internal validity of case-control studies. Little information exists on differences between population and hospital controls in case-control studies on cancers in Chinese hospital setting. We conducted three parallel case-control studies on leukemia, breast and colorectal cancers in China between 2009 and 2010, using population and hospital controls to separately match 540 incident cases by age, gender and residency at a 1:1 ratio. Demographic and lifestyle factors were measured using a validated questionnaire in face-to-face interview. Odds ratios (ORs) and 95% confidence intervals (CIs) were obtained using conditional logistic regression analyses. The two control groups had closely similar exposure distributions of 15 out of 16 factors, with the only exception being that hospital controls were less likely to have a BMI ≥ 25 (OR = 0.71, 95% CI: 0.54, 0.93). For exposure of green tea drinking, the adjusted ORs (95% CIs) comparing green tealeaves intake ≥ 1000 grams annually with non-drinkers were 0.51 (0.31, 0.83) and 0.21 (0.27, 0.74) for three cancers combined, 0.06 (0.01, 0.61) and 0.07 (0.01, 0.47) for breast cancer, 0.52 (0.29, 0.94) and 0.45 (0.25, 0.82) for colorectal cancer, 0.65 (0.08, 5.63) and 0.57 (0.07, 4.79) for leukemia using hospital and population controls respectively. The study found that hospital controls were comparable with population controls for most demographic characteristics and lifestyle factors measured, but there was a slight difference between the two control groups. Hospital outpatients provide a satisfactory control group in hospital-based case-control study in the Chinese hospital setting.

  7. Cerebrovascular insult hospital cases in the Clinical Hospital Mostar (Bosnia and Herzegovina) from 1999 to 2003--an example of an institutional register.

    PubMed

    Vasilj, Ivan; Cavaljuga, Semra; Petrović, Pavao; Ostojić, Ljerka; Ostojić, Zdenko; Kvesić, Ante; Martinović, Vlatka

    2006-09-01

    The analysis of a cerebro-vascular insult hospitalized cases in the Clinical Hospital Mostar as a retrospective epidemiological study was done in the Clinical Hospital Mostar for the period from 1999 to 2003. The major source of data was medical documentation of this hospital (an institutional register), the only hospital for the treatments of 457,491 inhabitants who gravitate by a health insurance for the treatment in this hospital. The study included a total of 1,555 cerebro-vascular insult cases treated in the Clinical Hospital Mostar Among them 727 (46.8%) were male patients, while 828 (53.2%) cases were female. The majority of the cases were above 50 years of life. Majority of treated female patients were older than 61 (45.6% of all cases), as well as among male patients (31.3%). The least number of cases was under 41 years in both groups (1.2%). Prevalence of risk factors was 2,035 cases (74%). During the same period risk factors research for entire Federation of Bosnia and Herzegovina (FBiH) was performed on the sample of 2,750 national insurance holders, out of which 852 gravitate for treatment in CB Mostar. Out of them 1.7% was found to suffer of cerebro vascular insult.

  8. Opportunities for improving post-hospital home medication management among older adults.

    PubMed

    Foust, Janice B; Naylor, Mary D; Boling, Peter A; Cappuzzo, Kimberly A

    2005-01-01

    Effective post-hospital home medication management among older adults is a convoluted, error-prone process. Older adults, whose complex medication regimens are often changed at hospital discharge, are susceptible to medication-related problems (e.g. Adverse Drug Events or ADEs) as they resume responsibility for managing their medications at home. Human error theory frames the discussion of multi-faceted, interacting factors including care system functions, like discharge medication teaching that contribute to post-hospital ADEs. The taxonomy and causes of post-hospital ADEs and related risk factors are reviewed, as we describe in high-risk older adults a population that may benefit from targeted interventions. Potential solutions and future research possibilities highlight the importance of interdisciplinary teams, involvement of clinical pharmacists, use of transitional care models, and improved use of informational technologies.

  9. The politics of local hospital reform: a case study of hospital reorganization following the 2002 Norwegian hospital reform

    PubMed Central

    2009-01-01

    Background The Norwegian hospital reform of 2002 was an attempt to make restructuring of hospitals easier by removing politicians from the decision-making processes. To facilitate changes seen as necessary but politically difficult, the central state took over ownership of the hospitals and stripped the county politicians of what had been their main responsibility for decades. This meant that decisions regarding hospital structure and organization were now being taken by professional administrators and not by politically elected representatives. The question raised here is whether this has had any effect on the speed of restructuring of the hospital sector. Method The empirical part is a case study of the restructuring process in Innlandet Hospital Trust (IHT), which was one of the largest enterprise established after the hospital reform and where the vision for restructuring was clearly set. Different sources of qualitative data are used in the analysis. These include interviews with key actors, observational data and document studies. Results The analysis demonstrates how the new professional leaders at first acted in accordance with the intentions of the hospital reform, but soon chose to avoid the more ambitious plans for restructuring the hospital structure and in fact reintroduced local politics into the decision-making process. The analysis further illustrates how local networks and engagement of political representatives from all levels of government complicated the decision-making process surrounding local structural reforms. Local political representatives teamed up with other actors and created powerful networks. At the same time, national politicians had incentives to involve themselves in the processes as supporters of the status quo. Conclusion Because of the incentives that faced political actors and the controversial nature of major hospital reforms, the removal of local politicians and the centralization of ownership did not necessarily facilitate

  10. The politics of local hospital reform: a case study of hospital reorganization following the 2002 Norwegian hospital reform.

    PubMed

    Tjerbo, Trond

    2009-11-20

    The Norwegian hospital reform of 2002 was an attempt to make restructuring of hospitals easier by removing politicians from the decision-making processes. To facilitate changes seen as necessary but politically difficult, the central state took over ownership of the hospitals and stripped the county politicians of what had been their main responsibility for decades. This meant that decisions regarding hospital structure and organization were now being taken by professional administrators and not by politically elected representatives. The question raised here is whether this has had any effect on the speed of restructuring of the hospital sector. The empirical part is a case study of the restructuring process in Innlandet Hospital Trust (IHT), which was one of the largest enterprise established after the hospital reform and where the vision for restructuring was clearly set. Different sources of qualitative data are used in the analysis. These include interviews with key actors, observational data and document studies. The analysis demonstrates how the new professional leaders at first acted in accordance with the intentions of the hospital reform, but soon chose to avoid the more ambitious plans for restructuring the hospital structure and in fact reintroduced local politics into the decision-making process. The analysis further illustrates how local networks and engagement of political representatives from all levels of government complicated the decision-making process surrounding local structural reforms. Local political representatives teamed up with other actors and created powerful networks. At the same time, national politicians had incentives to involve themselves in the processes as supporters of the status quo. Because of the incentives that faced political actors and the controversial nature of major hospital reforms, the removal of local politicians and the centralization of ownership did not necessarily facilitate reforms in the hospital structure

  11. A review of the medical treatment of pediatric glaucomas at Moorfields Eye Hospital.

    PubMed

    Chang, Lydia; Ong, Ee Lin; Bunce, Catey; Brookes, John; Papadopoulos, Maria; Khaw, Peng Tee

    2013-01-01

    To report on the medical treatments used for pediatric glaucomas. A retrospective case series consisting of reviewing the medical notes of pediatric glaucoma patients under the care of the Glaucoma Service at Moorfields Eye Hospital NHS Foundation Trust. The medical notes of 200 patients were selected. The following outcomes were assessed: (1) the use of individual medical therapies; (2) the intraocular pressure (IOP) reduction effect of individual medicines; (3) the reporting of side effects. Medicines were prescribed 1592 times (200 patients). The median % IOP reduction for latanoprost 50 mcg/mL was -17.2% and for the topical beta blockers was -17.7% (as monotherapy), with no statistical difference in IOP-lowering effect between all the medicines (P=0.19). Side effects were reported in 19.5% of all patients-the highest occurrence with brimonidine tartrate 0.2% (in 17% patients) and the lowest occurrence with the prostaglandin analogue and prostamide medicines (in 3.8% patients). The combination of dorzolamide hydrochloride 2%, timolol maleate 0.5% had the greatest persistence of 1 year. The IOP-lowering effects of all the glaucoma medicines were not significantly different although the combination of dorzolamide hydrochloride 2%, timolol maleate 0.5% had the greatest persistence.

  12. Factors influencing implementation of medical directives by registered nurses: the experience of a large Ontario teaching hospital.

    PubMed

    Alvarado, Kim

    2007-01-01

    To understand factors that affect the implementation of medical directives by registered nurses in a large teaching hospital. Qualitative nested case study. A large multi-site teaching hospital that utilizes over 20 different medical directives was chosen as the setting for this case study. Three distinct medical directives within this setting were selected to obtain maximum variation in the number of individuals involved in a particular directive and type of clinical area. Between March and October 2005, 27 individuals concerned with clinical implementation of these medical directives were interviewed using a semi-structured interview schedule. The registrars of two regulatory bodies that oversee policies related to medical directives and a consultant with expertise in medical directives were also interviewed. Eleven documents related to the use of medical directives were identified using purposive document sampling methods and were included in the study. Implementation of medical directives is influenced by a variety of factors, including nurse confidence and willingness to assume responsibility, the amount of new learning needed to carry out the directive and additional paperwork required. Perceived usefulness of the medical directive, physician support of nurses' use of the directives and frequency of encounter with that type of patient were also important factors. The implementation of a medical directive is a complex process; directives are difficult to write well and often affect the scope of practice of other healthcare professionals. The amount of education and monitoring required to implement a directive needs careful consideration to ensure the appropriate resources are available to support implementation. Greater attention to the factors that facilitate implementation of medical directives is required in order to implement directives in an efficient and effective manner.

  13. Analysis of Forensic Autopsy in 120 Cases of Medical Disputes Among Different Levels of Institutional Settings.

    PubMed

    Yu, Lin-Sheng; Ye, Guang-Hua; Fan, Yan-Yan; Li, Xing-Biao; Feng, Xiang-Ping; Han, Jun-Ge; Lin, Ke-Zhi; Deng, Miao-Wu; Li, Feng

    2015-09-01

    Despite advances in medical science, the causes of death can sometimes only be determined by pathologists after a complete autopsy. Few studies have investigated the importance of forensic autopsy in medically disputed cases among different levels of institutional settings. Our study aimed to analyze forensic autopsy in 120 cases of medical disputes among five levels of institutional settings between 2001 and 2012 in Wenzhou, China. The results showed an overall concordance rate of 55%. Of the 39% of clinically missed diagnosis, cardiovascular pathology comprises 55.32%, while respiratory pathology accounts for the remaining 44. 68%. Factors that increase the likelihood of missed diagnoses were private clinics, community settings, and county hospitals. These results support that autopsy remains an important tool in establishing causes of death in medically disputed case, which may directly determine or exclude the fault of medical care and therefore in helping in resolving these cases. © 2015 American Academy of Forensic Sciences.

  14. Prevalence and risk factors for medication reconciliation errors during hospital admission in elderly patients.

    PubMed

    Rodríguez Vargas, Blanca; Delgado Silveira, Eva; Iglesias Peinado, Irene; Bermejo Vicedo, Teresa

    2016-10-01

    Background Care transitions are risk points for medication discrepancies, especially in the elderly. Objective This study was undertaken to assess prevalence and describe medication reconciliation errors during admission in elderly patients and to analyze associated risk factors. We also evaluate the effect of these errors on the length of hospital stay. Setting General surgery, orthopedics, internal medicines and infectious diseases departments of a 1070-bed Spanish teaching hospital. Method This is a prospective observational study. Patients >65 years and taking ≥5 medications were randomly selected from those admitted to hospital. The pharmacist obtained the best possible medication history based on medical records, medical notes from patients' previous admissions to hospital, "brown bag" review, community care prescriptions, and comprehensive patient interviews. It was compared to current inpatient prescription to detect unintentional discrepancies (discrepancy with no apparent clinical explanation), which were reported to the physician. When the physician accepted the discrepancy by changing the medication order, it was recorded as a medication reconciliation error and classified by type of error. Several variables were analyzed as possible risk/protective factors. Main outcome measure Is prevalence of medication reconciliation errors at admission. Results Reconciliation was performed on 206 patients. Medication reconciliation errors occurred in 49.5 % (102/206) of patients. 1996 medications were recorded, and 359 had unintentional discrepancies (56.0 % (201/359) medication reconciliation errors). The most common was omission (65.1 %). Identified risk factors were as follows: physician experience, number of pre-admission prescribed medications, and previous surgeries. Computerized order entry system was a protective factor. Conclusion Medication reconciliation errors occur in almost half of the elderly patients at admission, especially omissions. Risk

  15. Clinical pharmacist-led program on medication reconciliation implementation at hospital admission: experience of a single university hospital in Croatia

    PubMed Central

    Marinović, Ivana; Marušić, Srećko; Mucalo, Iva; Mesarić, Jasna; Bačić Vrca, Vesna

    2016-01-01

    Aim To evaluate the clinical pharmacist-led medication reconciliation process in clinical practice by quantifying and analyzing unintentional medication discrepancies at hospital admission. Methods An observational prospective study was conducted at the Clinical Department of Internal Medicine, University Hospital Dubrava, during a 1-year period (October 2014 – September 2015) as a part of the implementation of Safe Clinical Practice, Medication Reconciliation of the European Network for Patient Safety and Quality of Care Joint Action (PASQ JA) project. Patients older than 18 years taking at least one regular prescription medication were eligible for inclusion. Discrepancies between pharmacists' Best Possible Medication History (BPMH) and physicians' admission orders were detected and communicated directly to the physicians to clarify whether the observed changes in therapy were intentional or unintentional. All discrepancies were discussed by an expert panel and classified according to their potential to cause harm. Results In 411 patients included in the study, 1200 medication discrepancies were identified, with 202 (16.8%) being unintentional. One or more unintentional medication discrepancy was found in 148 (35%) patients. The most frequent type of unintentional medication discrepancy was drug omission (63.9%) followed by an incorrect dose (24.2%). More than half (59.9%) of the identified unintentional medication discrepancies had the potential to cause moderate to severe discomfort or clinical deterioration in the patient. Conclusion Around 60% of medication errors were assessed as having the potential to threaten the patient safety. Clinical pharmacist-led medication reconciliation was shown to be an important tool in detecting medication discrepancies and preventing adverse patient outcomes. This standardized medication reconciliation process may be widely applicable to other health care organizations and clinical settings. PMID:28051282

  16. Making the business case for hospital information systems--a Kaiser Permanente investment decision.

    PubMed

    Garrido, Terhilda; Raymond, Brian; Jamieson, Laura; Liang, Louise; Wiesenthal, Andrew

    2004-01-01

    Further evidence in favor of the clinical IT business case is set forth in Kaiser Permanente's cost/benefit analysis for an electronic hospital information system. This article reviews the business case for an inpatient electronic medical record system, including 36 categories of quantifiable benefits that contribute to a positive cumulative net cash flow within an 8.5 year period. However, the business case hinges on several contingent success factors: leadership commitment, timely implementation, partnership with labor, coding compliance, and workflow redesign. The issues and constraints that impact the potential transferability of this business case across delivery systems raise questions that merit further attention.

  17. Medi-Cal Hospital Contracting—Did It Achieve Its Legislative Objectives?

    PubMed Central

    Brown, E. Richard; Price, Walter T.; Cousineau, Michael R.

    1985-01-01

    The 1982 Medi-Cal reforms and reductions established selective contracting with hospitals for inpatient care of Medi-Cal beneficiaries. The legislation established a special negotiator and criteria to be used in selecting contract hospitals. We report the findings of a study that analyzed the characteristics of contract and noncontract hospitals in Los Angeles County to assess how well these criteria were reflected in the outcome of the contracting process. We examine issues of beneficiary access to general inpatient care and to specialized services, the efficiency of contract hospitals compared with noncontract ones and quality-related issues. PMID:3898595

  18. Is the relationship between your hospital and your medical staff sustainable?

    PubMed

    Carlson, Greg; Greeley, Hugh

    2010-01-01

    Issues in the macro-environment are affecting the historic relationships that have existed between hospitals and their medical staffs over the last half century. Rising healthcare costs, deteriorating relationships, unexplained variations in clinical outcomes, transparency in healthcare outcomes, medical tourism, competition between hospitals and physicians, and reluctance by hospitals and physicians to change are among the issues challenging the sustainability of the current business model. This article highlights barriers to maintaining traditional relationships and concludes with strategies to preserve and strengthen relationships between physicians and hospitals.

  19. COPD and incident cardiovascular disease hospitalizations and mortality: Kaiser Permanente Medical Care Program.

    PubMed

    Sidney, Stephen; Sorel, Michael; Quesenberry, Charles P; DeLuise, Cynthia; Lanes, Stephan; Eisner, Mark D

    2005-10-01

    To determine the relationship between diagnosed and treated COPD and the incidence of cardiovascular disease (CVD) hospitalization and mortality. Retrospective matched cohort study. Northern California Kaiser Permanente Medical Care Program (KPNC), a comprehensive prepaid integrated health-care system. Case patients (n = 45,966) were all KPNC members with COPD who were identified during a 4-year period from January 1996 through December 1999. An equal number of control subjects without COPD were selected from KPNC membership and were matched for gender, year of birth, and length of KPNC membership. Follow-up conducted for hospitalization and mortality from CVD end points through December 31, 2000. CVD study end points included cardiac arrhythmias, angina pectoris, acute myocardial infarction, congestive heart failure (CHF), stroke, pulmonary embolism, all of the aforementioned study end points combined, other CVD, and all CVD end points. The mean follow-up time was 2.75 years for case patients and 2.99 years for control subjects. The risk of hospitalization was higher in COPD case patients than in control subjects for all CVD hospitalization and mortality end points. The relative risk (RR) for hospitalization for the composite measure of all study end points was 2.09 (95% confidence interval [CI], 1.99 to 2.20) after adjustment for gender, preexisting CVD study end points, hypertension, hyperlipidemia, and diabetes, and ranged from 1.33 (stroke) to 3.75 (CHF). The adjusted RR for mortality for the composite measure of all study end points was 1.68 (95% CI, 1.50 to 1.88), ranging from 1.25 (stroke) to 3.53 (CHF). Younger patients (ie, age < 65 years) and female patients had higher risks than older and male participants. COPD was a predictor of CVD hospitalization and mortality over an average follow-up time of nearly 3 years. The finding of a stronger relationship of COPD to CVD outcomes in patients < 65 years of age suggests that CVD risk should be monitored and

  20. Retrospective Analysis of the Blood Component Utilization in a University Hospital of Maximum Medical Care

    PubMed Central

    Geißler, R. Georg; Franz, Dominik; Buddendick, Hubert; Krakowitzky, Petra; Bunzemeier, Holger; Roeder, Norbert; Van Aken, Hugo; Kessler, Torsten; Berdel, Wolfgang; Sibrowski, Walter; Schlenke, Peter

    2012-01-01

    Background Demographic data illustrate clearly that people in highly developed countries get older, and the elderly need more blood transfusions than younger patients. Additionally, special extensive therapies result in an increased consumption of blood components. Beyond that the aging of the population reduces the total number of preferably young and healthy blood donors. Therefore, Patient Blood Management will become more and more important in order to secure an increasing blood supply under fair-minded conditions. Methods At the University Hospital of Münster (UKM) a comprehensive retrospective analysis of the utilization of all conventional blood components was performed including all medical and surgical disciplines. In parallel, a new medical reporting system was installed to provide a monthly analysis of the transfusional treatments in the whole infirmary, in every department, and in special blood-consuming cases of interest, as well. Results The study refers to all UKM in-patient cases from 2009 to 2011. It clearly demonstrates that older patients (>60 years, 35.2–35.7% of all cases, but 49.4–52.6% of all cases with red blood cell (RBC) transfusions, 36.4–41. 6% of all cases with platelet (PTL, apheresis only) transfusions, 45.2–48.0% of all cases with fresh frozen plasma (FFP) transfusions) need more blood products than younger patients. Male patients (54.4–63.9% of all cases with transfusions) are more susceptible to blood transfusions than female patients (36.1–45.6% of all cases with transfusions). Most blood components are used in cardiac, visceral, and orthopedic surgery (49.3–55.9% of all RBC units, 45.8–61.0% of all FFP units). When regarding medical disciplines, most transfusions are administered to hematologic and oncologic patients (12.9–17.7% of all RBC units, 9.2–12.0% of all FFP units). The consumption of PTL in this special patient cohort (40.6–50.9% of all PTL units) is more pronounced than in all other surgical or

  1. [Prediction of further hospital treatment for emergency patients by emergency medical service physicians].

    PubMed

    Bernhard, M; Trautwein, S; Stepan, R; Zahn, P; Greim, C-A; Gries, A

    2014-05-01

    Prehospital assessment of illness and injury severity with the National Advisory Committee for Aeronautics (NACA) score and hospital pre-arrival notification of a patient who is likely to need intensive care unit (ICU) or intermediate care unit (IMC) admission are both common in Germany's physician-staffed emergency medical services (EMS) system. This study aimed at comparing the prehospital evaluation of severity of disease or injuries by EMS physicians and the subsequent clinical treatment in unselected emergency department (ED) patients. This study involved a prospective observational analysis of patients transported to the ED of an academic level I hospital escorted by an EMS physician over a period of 6 months (February-July 2011). The physician's qualification and the patient's NACA score were documented and the EMS physician was asked to predict whether the patient would need hospital admission and, if so, to the general ward, IMC or ICU. After the ED treatment, discharge or admission, outcome and length of hospital and ICU or IMC stay were documented. A total of 378 mostly non-trauma patients (88 %) treated by experienced EMS physicians could be enrolled. The number of patients discharged from the ED decreased, while the number of patients admitted to the ICU increased with higher NACA scores. Prehospital prediction of discharge or admission, IMC or ICU treatment by EMS physicians was accurate in 47 % of the patients. In 40 % of patients a lower level of care was sufficient while 12 % needed treatment on a higher level of care than that predicted by EMS physicians. Of the patients 39 % who were predicted to be discharged after ED treatment, were admitted to hospital and 48 % of patients predicted to be admitted to the IMC were admitted to the general ward. Patients predicted to be admitted to the ICU were admitted to the ICU in 75 %. Higher NACA scores were associated with increased mortality and a longer hospital IMC or ICU length of stay

  2. A national survey of inpatient medication systems in English NHS hospitals

    PubMed Central

    2014-01-01

    Background Systems and processes for prescribing, supplying and administering inpatient medications can have substantial impact on medication administration errors (MAEs). However, little is known about the medication systems and processes currently used within the English National Health Service (NHS). This presents a challenge for developing NHS-wide interventions to increase medication safety. We therefore conducted a cross-sectional postal census of medication systems and processes in English NHS hospitals to address this knowledge gap. Methods The chief pharmacist at each of all 165 acute NHS trusts was invited to complete a questionnaire for medical and surgical wards in their main hospital (July 2011). We report here the findings relating to medication systems and processes, based on 18 closed questions plus one open question about local medication safety initiatives. Non-respondents were posted another questionnaire (August 2011), and then emailed (October 2011). Results One hundred (61% of NHS trusts) questionnaires were returned. Most hospitals used paper-based prescribing on the majority of medical and surgical inpatient wards (87% of hospitals), patient bedside medication lockers (92%), patients’ own drugs (89%) and ‘one-stop dispensing’ medication labelled with administration instructions for use at discharge as well as during the inpatient stay (85%). Less prevalent were the use of ward pharmacy technicians (62% of hospitals) or pharmacists (58%) to order medications on the majority of wards. Only 65% of hospitals used drug trolleys; 50% used patient-specific inpatient supplies on the majority of wards. Only one hospital had a pharmacy open 24 hours, but all had access to an on-call pharmacist. None reported use of unit-dose dispensing; 7% used an electronic drug cabinet in some ward areas. Overall, 85% of hospitals had a double-checking policy for intravenous medication and 58% for other specified drugs. “Do not disturb” tabards

  3. The association between insurance status and in-hospital mortality on the public medical wards of a Kenyan referral hospital.

    PubMed

    Stone, Geren S; Tarus, Titus; Shikanga, Mainard; Biwott, Benson; Ngetich, Thomas; Andale, Thomas; Cheriro, Betsy; Aruasa, Wilson

    2014-01-01

    Observational data in the United States suggests that those without health insurance have a higher mortality and worse health outcomes. A linkage between insurance coverage and outcomes in hospitalized patients has yet to be demonstrated in resource-poor settings. To determine whether uninsured patients admitted to the public medical wards at a Kenyan referral hospital have any difference in in-hospital mortality rates compared to patients with insurance, we performed a retrospective observational study of all inpatients discharged from the public medical wards at Moi Teaching and Referral Hospital in Eldoret, Kenya, over a 3-month study period from October through December 2012. The primary outcome of interest was in-hospital death, and the primary explanatory variable of interest was health insurance status. During the study period, 201 (21.3%) of 956 patients discharged had insurance. The National Hospital Insurance Fund was the only insurance scheme noted. Overall, 211 patients (22.1%) died. The proportion who died was greater among the uninsured compared to the insured (24.7% vs. 11.4%, Chi-square = 15.6, p<0.001). This equates to an absolute risk reduction of 13.3% (95% CI 7.9-18.7%) and a relative risk reduction of 53.8% (95% CI 30.8-69.2%) of in-hospital mortality with insurance. After adjusting for comorbid illness, employment status, age, HIV status, and gender, the association between insurance status and mortality remained statistically significant (adjusted odds ratio (AOR) = 0.40, 95% CI 0.24-0.66) and similar in magnitude to the association between HIV status and mortality (AOR = 2.45, 95% CI 1.56-3.86). Among adult patients hospitalized in a public referral hospital in Kenya, insurance coverage was associated with decreased in-hospital mortality. This association was comparable to the relationship between HIV and mortality. Extension of insurance coverage may yield substantial benefits for population health.

  4. Medication supply chain management through implementation of a hospital pharmacy computerized inventory program in Haiti.

    PubMed

    Holm, Michelle R; Rudis, Maria I; Wilson, John W

    2015-01-01

    Background In the aftermath of the 2010 earthquake in Haiti, St. Luke Hospital was built to help manage the mass casualties and subsequent cholera epidemic. A major problem faced by the hospital system was the lack of an available and sustainable supply of medications. Long-term viability of the hospital system depended largely on developing an uninterrupted medication supply chain. Objective We hypothesized that the implementation of a new Pharmacy Computerized Inventory Program (PCIP) would optimize medication availability and decrease medication shortages. Design We conducted the research by examining how medications were being utilized and distributed before and after the implementation of PCIP. We measured the number of documented medication transactions in both Phase 1 and Phase 2 as well as user logins to determine if a computerized inventory system would be beneficial in providing a sustainable, long-term solution to their medication management needs. Results The PCIP incorporated drug ordering, filling the drug requests, distribution, and dispensing of the medications in multiple settings; inventory of currently shelved medications; and graphic reporting of 'real-time' medication usage. During the PCIP initiation and establishment periods, the number of medication transactions increased from 219.6 to 359.5 (p=0.055), respectively, and the mean logins per day increased from 24.3 to 31.5, p<0.0001, respectively. The PCIP allows the hospital staff to identify and order medications with a critically low supply as well as track usage for future medication needs. The pharmacy and nursing staff found the PCIP to be efficient and a significant improvement in their medication utilization. Conclusions An efficient, customizable, and cost-sensitive PCIP can improve drug inventory management in a simplified and sustainable manner within a resource-constrained hospital.

  5. Medication supply chain management through implementation of a hospital pharmacy computerized inventory program in Haiti.

    PubMed

    Holm, Michelle R; Rudis, Maria I; Wilson, John W

    2015-01-01

    In the aftermath of the 2010 earthquake in Haiti, St. Luke Hospital was built to help manage the mass casualties and subsequent cholera epidemic. A major problem faced by the hospital system was the lack of an available and sustainable supply of medications. Long-term viability of the hospital system depended largely on developing an uninterrupted medication supply chain. We hypothesized that the implementation of a new Pharmacy Computerized Inventory Program (PCIP) would optimize medication availability and decrease medication shortages. We conducted the research by examining how medications were being utilized and distributed before and after the implementation of PCIP. We measured the number of documented medication transactions in both Phase 1 and Phase 2 as well as user logins to determine if a computerized inventory system would be beneficial in providing a sustainable, long-term solution to their medication management needs. The PCIP incorporated drug ordering, filling the drug requests, distribution, and dispensing of the medications in multiple settings; inventory of currently shelved medications; and graphic reporting of 'real-time' medication usage. During the PCIP initiation and establishment periods, the number of medication transactions increased from 219.6 to 359.5 (p=0.055), respectively, and the mean logins per day increased from 24.3 to 31.5, p<0.0001, respectively. The PCIP allows the hospital staff to identify and order medications with a critically low supply as well as track usage for future medication needs. The pharmacy and nursing staff found the PCIP to be efficient and a significant improvement in their medication utilization. An efficient, customizable, and cost-sensitive PCIP can improve drug inventory management in a simplified and sustainable manner within a resource-constrained hospital.

  6. Prevalence and cost of hospital medical errors in the general and elderly United States populations.

    PubMed

    Mallow, Peter J; Pandya, Bhavik; Horblyuk, Ruslan; Kaplan, Harold S

    2013-12-01

    The primary objective of this study was to quantify the differences in the prevalence rate and costs of hospital medical errors between the general population and an elderly population aged ≥65 years. Methods from an actuarial study of medical errors were modified to identify medical errors in the Premier Hospital Database using data from 2009. Visits with more than four medical errors were removed from the population to avoid over-estimation of cost. Prevalence rates were calculated based on the total number of inpatient visits. There were 3,466,596 total inpatient visits in 2009. Of these, 1,230,836 (36%) occurred in people aged ≥ 65. The prevalence rate was 49 medical errors per 1000 inpatient visits in the general cohort and 79 medical errors per 1000 inpatient visits for the elderly cohort. The top 10 medical errors accounted for more than 80% of the total in the general cohort and the 65+ cohort. The most costly medical error for the general population was postoperative infection ($569,287,000). Pressure ulcers were most costly ($347,166,257) in the elderly population. This study was conducted with a hospital administrative database, and assumptions were necessary to identify medical errors in the database. Further, there was no method to identify errors of omission or misdiagnoses within the database. This study indicates that prevalence of hospital medical errors for the elderly is greater than the general population and the associated cost of medical errors in the elderly population is quite substantial. Hospitals which further focus their attention on medical errors in the elderly population may see a significant reduction in costs due to medical errors as a disproportionate percentage of medical errors occur in this age group.

  7. Medication supply chain management through implementation of a hospital pharmacy computerized inventory program in Haiti

    PubMed Central

    Holm, Michelle R.; Rudis, Maria I.; Wilson, John W.

    2015-01-01

    Background In the aftermath of the 2010 earthquake in Haiti, St. Luke Hospital was built to help manage the mass casualties and subsequent cholera epidemic. A major problem faced by the hospital system was the lack of an available and sustainable supply of medications. Long-term viability of the hospital system depended largely on developing an uninterrupted medication supply chain. Objective We hypothesized that the implementation of a new Pharmacy Computerized Inventory Program (PCIP) would optimize medication availability and decrease medication shortages. Design We conducted the research by examining how medications were being utilized and distributed before and after the implementation of PCIP. We measured the number of documented medication transactions in both Phase 1 and Phase 2 as well as user logins to determine if a computerized inventory system would be beneficial in providing a sustainable, long-term solution to their medication management needs. Results The PCIP incorporated drug ordering, filling the drug requests, distribution, and dispensing of the medications in multiple settings; inventory of currently shelved medications; and graphic reporting of ‘real-time’ medication usage. During the PCIP initiation and establishment periods, the number of medication transactions increased from 219.6 to 359.5 (p=0.055), respectively, and the mean logins per day increased from 24.3 to 31.5, p<0.0001, respectively. The PCIP allows the hospital staff to identify and order medications with a critically low supply as well as track usage for future medication needs. The pharmacy and nursing staff found the PCIP to be efficient and a significant improvement in their medication utilization. Conclusions An efficient, customizable, and cost-sensitive PCIP can improve drug inventory management in a simplified and sustainable manner within a resource-constrained hospital. PMID:25623613

  8. Incidence of cutaneous adverse drug reactions among medical inpatients of Sultanah Aminah Hospital Johor Bahru.

    PubMed

    Latha, S; Choon, S E

    2017-06-01

    Cutaneous adverse drug reactions (cADRs) are common. There are only few studies on the incidence of cADRs in Malaysia. To determine the incidence, clinical features and risk factors of cADRs among hospitalized patients. A prospective study was conducted among medical inpatients from July to December 2014. A total of 43 cADRs were seen among 11 017 inpatients, yielding an incidence rate of 0.4%. cADR accounted for hospitalization in 26 patients. Previous history of cADR was present in 14 patients, with 50% exposed to the same drug taken previously. Potentially lifethreatening severe cutaneous adverse reactions (SCAR), namely drug reaction with eosinophilia and systemic symptoms (DRESS: 14 cases) and Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN: 6 cases) comprise almost 50% of cADRs. The commonest culprit drug group was antibiotics (37.2%), followed by anticonvulsants (18.6%). Cotrimoxazole, phenytoin and rifampicin were the main causative drugs for DRESS. Anticonvulsants were most frequently implicated in SJS/TEN (66.7%). Most cases had "probable" causality relationship with suspected drug (69.8%). The majority of cases were of moderate severity (65.1%), while 18.6% had severe reaction with 1 death recorded. Most cases were not preventable (76.7%). Older age (> 60 years) and mucosal involvement were significantly associated with a more severe reaction. The incidence of cADRs was 0.4%, with most cases classified as moderate severity and not preventable. The commonest reaction pattern was DRESS, while the main culprit drug group was antibiotics. Older age and mucosal membrane involvement predicts a severe drug reaction.

  9. Cancer registration using case history database in hospital information system.

    PubMed

    Nose, Y; Akazawa, K; Watanabe, Y; Yokota, M; Okamura, S; Maehara, Y; Sugimachi, K

    1988-07-01

    The World Health Organization (WHO) recommendations for hospital cancer registration, although being effective for combating the disease, need heavy manpower for complete implementation. A computer-based method for cancer registration is in use at Kyushu University Hospital as part of the integrated hospital information system. This method needs no manpower for data gathering, and the database includes almost all the core data and half of optional data recommended for cancer registration by the WHO. This database can, therefore, be regarded as a file for hospital cancer registration, and is used for two applications. The prepared form is automatically completed for the regional cancer register by a computer program without involving any physicians' time. In addition, a decision support system for the protocol used for a patient with a cancer was developed. Trendtables and graphs of clinical examination and medication are displayed, with suggestions and warning for physicians to help them make clinical decisions.

  10. INTRODUCTION OF INNOVATIVE MEDICAL DEVICES AT FRENCH UNIVERSITY HOSPITALS: AN OVERVIEW OF HOSPITAL-BASED HEALTH TECHNOLOGY ASSESSMENT INITIATIVES.

    PubMed

    Martelli, Nicolas; Billaux, Mathilde; Borget, Isabelle; Pineau, Judith; Prognon, Patrice; van den Brink, Helene

    2015-01-01

    Local health technology assessment (HTA) to determine whether new health technologies should be adopted is now a common practice in many healthcare organizations worldwide. However, little is known about hospital-based HTA activities in France. The objective of this study was to explore hospital-based HTA activities in French university hospitals and to provide a picture of organizational approaches to the assessment of new and innovative medical devices. Eighteen semi-structured interviews with hospital pharmacists were conducted from October 2012 to April 2013. Six topics were discussed in depth: (i) the nature of the institution concerned; (ii) activities relating to innovative medical devices; (iii) the technology assessment and decision-making process; (iv) the methodology for technology assessment; (v) factors likely to influence decisions and (vi) suggestions for improving the current process. The interview data were coded, collated and analyzed statistically. Three major types of hospital-based HTA processes were identified: medical device committees, innovation committees, and "pharmacy & management" processes. HTA units had been set up to support medical device and innovation committees for technology assessment. Slow decision making was the main limitation to both these committee-based approaches. As an alternative, "pharmacy & management" processes emerged as a means of rapidly obtaining a formal assessment. This study provides an overview of hospital-based HTA initiatives in France. We hope that it will help to promote hospital-based HTA activities in France and discussions about ways to improve and harmonize practices, through the development of national guidelines and/or a French mini-HTA tool, for example.

  11. The Safe Medical Devices Act of 1990: are hospitals ready to deal with the FDA?

    PubMed

    Loob, W H

    1991-01-01

    The Safe Medical Devices Act of 1990, long anticipated by regulatory affairs and compliance professionals in the medical device manufacturing industry, was signed by President George Bush on November 28, 1990. The law will significantly alter the structure of medical device regulatory mechanisms, and will expand the scope of the FDA's activities. The new medical device legislation sets requirements for hospitals as well as industry.

  12. [The management of implantable medical device and the application of the internet of things in hospitals].

    PubMed

    Zhou, Li; Xu, Liang

    2011-11-01

    Implantable medical device is a special product which belongs to medical devices. It not only possesses product characteristics in common, but also has specificity for safety and effectiveness. Implantable medical device must be managed by the relevant laws and regulations of the State Food and Drug Administration. In this paper, we have used cardiac pacemakers as an example to describe the significance of the management of implantable medical device products and the application of the internet of things in hospitals.

  13. Associated Roles of Perioperative Medical Directors and Anesthesia: Hospital Agreements for Operating Room Management.

    PubMed

    Dexter, Franklin; Epstein, Richard H

    2015-12-01

    As reviewed previously, decision making can be made systematically shortly before the day of surgery based on reducing the hours of overutilized operating room (OR) time and tardiness of case starts (i.e., patient waiting). We subsequently considered in 2008 that such decision making depends on rational anesthesia-hospital agreements specifying anesthesia staffing. Since that prior study, there has been a substantial increase in understanding of the timing of decision making to reduce overutilized OR time. Most decisions substantively influencing overutilized OR time are those made within 1 workday before the day of surgery and on the day of surgery, because only then are ORs sufficiently full that case scheduling and staff assignment decisions affect overutilized OR time. Consequently, anesthesiologists can easily be engaged in such decisions, because generally they must be involved to ensure that the corresponding anesthesia staff assignments are appropriate. Despite this, at hospitals with >8 hours of OR time used daily in each OR, computerized recommendations are superior to intuition because of cognitive biases. Decisions need to be made by a Perioperative Medical Director who has knowledge of the principles of perioperative managerial decision making published in the scientific literature rather than by a committee lacking this competency. Education in the scientific literature, and when different analytical methods should be used, is important. The addition that we make in this article is to show that an agreement between an anesthesia group and a hospital can both reduce overutilized OR time and patient waiting: The anesthesia group and hospital will ensure, hourly, that, when there are case(s) waiting to start, the number of ORs in use for each service will be at least the number that maximizes the efficiency of use of OR time. Neither the anesthesia group nor the hospital will be expected to run more than that number of ORs without mutual agreement

  14. 20 CFR 404.1051 - Payments on account of sickness or accident disability, or related medical or hospitalization...

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... disability, or related medical or hospitalization expenses. 404.1051 Section 404.1051 Employees' Benefits... accident disability, or related medical or hospitalization expenses. (a) We do not include as wages any... disability, or related medical or hospitalization expenses, if the payment is made more than 6 consecutive...

  15. 38 CFR 17.121 - Limitations on payment or reimbursement of the costs of emergency hospital care and medical...

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... reimbursement of the costs of emergency hospital care and medical services not previously authorized. 17.121... reimbursement of the costs of emergency hospital care and medical services not previously authorized. Claims for payment or reimbursement of the costs of emergency hospital care or medical services not...

  16. 38 CFR 17.121 - Limitations on payment or reimbursement of the costs of emergency hospital care and medical...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... reimbursement of the costs of emergency hospital care and medical services not previously authorized. 17.121... reimbursement of the costs of emergency hospital care and medical services not previously authorized. Claims for payment or reimbursement of the costs of emergency hospital care or medical services not...

  17. Incidence of Natal Teeth in Newborns in Government Medical College and Hospital, Chengalpattu: A Pilot Study

    PubMed Central

    Kuppuswami, Niraimathy

    2017-01-01

    Introduction Natal teeth are teeth which are seen at birth and neonatal teeth erupt during the first thirty days after birth. Exact cause is however unknown but trauma, malnutrition, infection or environmental factor can be the causitive factor. Different studies have shown different incident rates. Aim To find the incidence of natal teeth in neonates born in the hospital over a period of seven months and also to find out the most commonly occurring natal teeth among them. Materials and Methods The present study was conducted in the Government Medical College and Hospital, Chengalpattu, Chennai, Tamil Nadu, India, for a period of seven months. A questionnaire was given to the mothers for gaining relevant information regarding the age, gender of neonate, type of delivery, etc. The cohort of neonates delivered in the hospital was examined clinically to note the presence of natal teeth. Results Out of 4,341 children four neonates were born with natal teeth. Our study showed female preponderance and most commonly erupted teeth were mandibular anteriors. The type of delivery had no significant relation with the presence or absence of natal teeth. Conclusion The presence of natal teeth was very rare in our study group. The neonates with natal teeth should be thoroughly examined and parent counselling is also important in these cases. PMID:28571270

  18. Medication prescribing patterns among chronic kidney disease patients in a hospital in Malaysia.

    PubMed

    Al-Ramahi, Rowa

    2012-03-01

    To determine the medication prescribing patterns in hospitalized patients with chronic kidney disease (CKD) in a Malaysian hospital, we prospectively studied a cohort of 600 patients in two phases with 300 patients in each phase. The first phase was carried out from the beginning of February to the end of May 2007, and the second phase was from the beginning of March to the end of June 2008. Patients with CKD who had an estimated creatinine clearance ≤ 50 mL/min and were older than 18 years were included. A data collection form was used to collect data from the patients' medical records and chart review. All systemic medications prescribed during hospitalization were included. The patients were prescribed 5795 medications. During the first phase, the patients were prescribed 2814 medication orders of 176 different medications. The prescriptions were 2981 of 158 medications during the second phase. The mean number of medications in the first and second phases was 9.38 ± 3.63 and 9.94 ± 3.78 respectively (P-value = 0.066). The top five used medications were calcium carbonate, folic acid/vitamin B complex, metoprolol, lovastatin, and ferrous sulfate. The most commonly used medication classes were mineral supplements, vitamins, antianemic preparations, antibacterials, and beta-blocking agents. This study provides an overview of prescription practice in a cohort of hospitalized CKD patients and indicates possible areas of improvement in prescription practice.

  19. Patients' satisfaction with inpatient services provided in hospitals affiliated to Tehran University of Medical Sciences, Iran, during 2011-2013

    PubMed Central

    Makarem, Jalil; Larijani, Bagher; Joodaki, Kobra; Ghaderi, Sahar; Nayeri, Fatemeh; Mohammadpoor, Masoud

    2016-01-01

    Implementation of patient feedback is considered as a critical part of effective and efficient management in developed countries. The main objectives of this study were to assess patient satisfaction with the services provided in hospitals affiliated to Tehran University of Medical Sciences, Iran, identify areas of patient dissatisfaction, and find ways to improve patient satisfaction with hospital services. This cross-sectional study was conducted in 3 phases. After 2 initial preparation phases, the valid instrument was applied through telephone interviews with 21476 participants from 26 hospitals during August, 2011 to February, 2013.Using the Satisfaction Survey tool, information of patient's demographic characteristics were collected and patient satisfaction with 15 areas of hospital services and the intent to return the same hospitals were assessed. The mean score of overall satisfaction with hospital services was 16.86 ± 2.72 out of 20. It was found that 58% of participants were highly satisfied with the services provided. Comparison of mean scores showed physician and medical services (17.75 ± 4.02), laboratory and radiology services (17.67 ± 3.66), and privacy and religious issues (17.55 ± 4.32) had the highest satisfaction. The patients were the most dissatisfied with the food services (15.50 ± 5.54). It was also found that 83.7% of the participants intended to return to the same hospital in case of need, which supported the measured satisfaction level. Patient satisfaction in hospitals affiliated to Tehran University of Medical Sciences was high. It seems that the present study, with its large sample size, has sufficient reliability to express the patient satisfaction status. Moreover, appropriate measures should be taken in some areas (food, cost, and etc.) to increase patient satisfaction. PMID:27471589

  20. Connecting hospitalized patients with their families: case series and commentary.

    PubMed

    Parsapour, Kourosh; Kon, Alexander A; Dharmar, Madan; McCarthy, Amy K; Yang, Hsuan-Hui; Smith, Anthony C; Carpenter, Janice; Sadorra, Candace K; Farbstein, Aron D; Hojman, Nayla M; Wold, Gary L; Marcin, James P

    2011-01-01

    The overall aim of this project was to ascertain the utilization of a custom-designed telemedicine service for patients to maintain close contact (via videoconference) with family and friends during hospitalization. We conducted a retrospective chart review of hospitalized patients (primarily children) with extended hospital length of stays. Telecommunication equipment was used to provide videoconference links from the patient's bedside to friends and family in the community. Thirty-six cases were managed during a five-year period (2006 to 2010). The most common reasons for using Family-Link were related to the logistical challenges of traveling to and from the hospital-principally due to distance, time, family commitments, and/or personal cost. We conclude that videoconferencing provides a solution to some barriers that may limit family presence and participation in care for hospitalized patients, and as a patient-centered innovation is likely to enhance patient and family satisfaction.

  1. The case for medical marijuana in epilepsy.

    PubMed

    Maa, Edward; Figi, Paige

    2014-06-01

    Charlotte, a little girl with SCN1A-confirmed Dravet syndrome, was recently featured in a special that aired on CNN. Through exhaustive personal research and assistance from a Colorado-based medical marijuana group (Realm of Caring), Charlotte's mother started adjunctive therapy with a high concentration cannabidiol/Δ(9) -tetrahydrocannabinol (CBD:THC) strain of cannabis, now known as Charlotte's Web. This extract, slowly titrated over weeks and given in conjunction with her existing antiepileptic drug regimen, reduced Charlotte's seizure frequency from nearly 50 convulsive seizures per day to now 2-3 nocturnal convulsions per month. This effect has persisted for the last 20 months, and Charlotte has been successfully weaned from her other antiepileptic drugs. We briefly review some of the history, preclinical and clinical data, and controversies surrounding the use of medical marijuana for the treatment of epilepsy, and make a case that the desire to isolate and treat with pharmaceutical grade compounds from cannabis (specifically CBD) may be inferior to therapy with whole plant extracts. Much more needs to be learned about the mechanisms of antiepileptic activity of the phytocannabinoids and other constituents of Cannabis sativa. Wiley Periodicals, Inc. © 2014 International League Against Epilepsy.

  2. Absence of appropriate hospitalization cost control for patients with medical insurance: a comparative analysis study.

    PubMed

    Pan, Xilong; Dib, Hassan H; Zhu, Minmin; Zhang, Ying; Fan, Yang

    2009-10-01

    Expose the weak loops in the Chinese medical insurance coverage and uncover hospitals' role of over-pricing hospitalized insured patients compared with those non-insured. A multi-linear regression method was used to analyze hospitalization expense for insured and uninsured patients with uncomplicated acute appendicitis, cholecystitis, benign uterine tumors, and normal delivery. Hospitalization cost is higher among insured than uninsured patients due to longer hospitalization lengths of stay, type of disease (highest among cholecystitis patients), type of gender - females, old-aged people, and type of marital status - singles, as well as drugs expenses, surgical expenses, and other medical acts. Require a better government's supervision system over medical insurance expenses such as reforming methods of payments, building up new cost compensation mechanism, and unifying and stabilizing prices for each category of medicines.

  3. Integration of an academic medical center and a community hospital: the Brigham and Women's/Faulkner hospital experience.

    PubMed

    Sussman, Andrew J; Otten, Jeffrey R; Goldszer, Robert C; Hanson, Margaret; Trull, David J; Paulus, Kenneth; Brown, Monte; Dzau, Victor; Brennan, Troyen A

    2005-03-01

    Brigham and Women's Hospital (BWH), a major academic tertiary medical center, and Faulkner Hospital (Faulkner), a nearby community teaching hospital, both in the Boston, Massachusetts area, have established a close affiliation relationship under a common corporate parent that achieves a variety of synergistic benefits. Formed under the pressures of limited capacity at BWH and excess capacity at Faulkner, and the need for lower-cost clinical space in an era of provider risk-sharing, BWH and Faulkner entered into a comprehensive affiliation agreement. Over the past seven years, the relationship has enhanced overall volume, broadened training programs, lowered the cost of resources for secondary care, and improved financial performance for both institutions. The lessons of this relationship, both in terms of success factors and ongoing challenges for the hospitals, medical staffs, and a large multispecialty referring physician group, are reviewed. The key factors for success of the relationship have been integration of training programs and some clinical services, provision of complementary clinical capabilities, geographic proximity, clear role definition of each institution, commitment and flexibility of leadership and medical staff, active and responsive communication, and the support of a large referring physician group that embraced the affiliation concept. Principal challenges have been maintaining the community hospital's cost structure, addressing cultural differences, avoiding competition among professional staff, anticipating the pace of patient migration, choosing a name for the new affiliation, and adapting to a changing payer environment.

  4. Applicability Flowchart for Hospital/Medical/Infectious Waste Incinerators (HIMWI) Amended October 6, 2009

    EPA Pesticide Factsheets

    This October 2009 document contains a diagram that that are intended to assist you in determining whether you own or operate any equipment that is subject to the Hospital/Medical/Infectious Waste Incinerators (HIMWI) regulations.

  5. [Medical microbiology laboratories in Dutch hospitals: essential for safe patient care].

    PubMed

    Bonten, M J M

    2008-12-06

    The Netherlands Health Care Inspectorate investigated the quality of medical microbiology laboratories in Dutch hospitals. By and large the laboratories fulfilled the requirements for appropriate care, although some processes were unsatisfactory and some were insufficiently formalised. In the Netherlands, laboratories for medical microbiology are integrated within hospitals and medical microbiologists are responsible for the diagnostic processes as well as for co-treatment of patients, infection prevention and research. This integrated model contrasts to the more industrialised model in many other countries, where such laboratories are physically distinct from hospitals with a strong focus on diagnostics. The Inspectorate also concludes that the current position of medical microbiology in Dutch hospitals is necessary for patient safety and that outsourcing of these facilities is considered unacceptable.

  6. Perceived Pain and Satisfaction with Medical Rehabilitation after Hospital Discharge

    PubMed Central

    Bergés, Ivonne-Marie; Ottenbacher, Kenneth J.; Smith, Pamela M.; Smith, David; Ostir, Glenn V.

    2007-01-01

    Objective To examine the association between pain and satisfaction with medical rehabilitation in patients with hip or knee replacement approximately 90 days after discharge from in-patient medical rehabilitation. Design A cross-sectional design. Participants The sample included 2,507 patients with hip or knee replacement using information from the IT HealthTrack medical outcome database. Main outcome measure Satisfaction with medical rehabilitation. Results The average age was 70.2 years, 66.5% were female, and 88.5% were non-Hispanic white. Pain scores were significantly and inversely associated with satisfaction with medical rehabilitation after adjustment for possible confounding factors. In patients with hip replacement each one-point increase in pain score was associated with a 10% decreased odds ratio of being satisfied with medical rehabilitation (OR 0.90, 95 % CI: 0.84, 0.96). In patients with knee replacement, each one-point increase in pain score was associated with a 9% decreased odds ratio (OR 0.91, 95% CI: 0.87, 0.96) of being satisfied with medical rehabilitation. Conclusion Our data indicate that postoperative pain from hip or knee replacement is associated with reduced satisfaction with medical rehabilitation. Better post-operative pain control may improve a patient’s level of satisfaction. PMID:16944829

  7. Frequency of Inappropriate Medication Prescription in Hospitalized Elderly Patients in Italy

    PubMed Central

    Napolitano, Francesco; Izzo, Maria Teresa; Di Giuseppe, Gabriella; Angelillo, Italo F.; Castaldo, Vincenzo; De Stefano, Andreo A; Dell'Aversano, Raffaele; di Mauro, Maurizio; Iodice, Vincenzo; Iovine, Carmine; Matarazzo, Giuseppe; Rota, Giacomo; Sciambra, Antonio

    2013-01-01

    Background Older people often need comprehensive treatment, including many medications, and polypharmacy is common. The aims of this cross-sectional investigation were to examine the potentially inappropriate medication during the hospitalization and to identify the factors that may influence such inappropriateness among elderly in Italy. Methods A sample of 605 individuals aged 65 years and older admitted in non-academic public acute care hospitals was randomly selected. Prescription of inappropriate medications were evaluated during the period from the day of admission to a randomly preselected day (index day). Beers Criteria were used to evaluate appropriateness. Results At least one potentially inappropriate medication prescription from the day of hospital admission to the index day has been observed in 188 patients (31.1%), and respectively 84.1% and 15.9% of them had received one or two inappropriate medications. A total of 15 medications was prescribed inappropriately to these 188 patients, for 215 times with a total of 1143 doses. The multivariate logistic regression analysis revealed that the significant predictors for having at least one potentially inappropriate medication prescription during the hospitalization were: patients having an elementary education level, a lower pre-admission performance-based measure of basic activities of daily living, having received an inappropriate drug before the hospitalization, a hospital stay in the general and in the specialties surgical wards, a longer length of hospital stay from the admission to the index day, and having received a higher number of drugs from the day of the hospital admission to the index day. The most prevalent inappropriate medications administered were ketorolac (27.4%), amiodarone (19.1%), and clonidine (11.2%). Conclusions This study supports the need for clinical guidelines implementation to assist physicians in choosing the most appropriate drugs for the elderly and for effective education

  8. Impact of electronic medication reconciliation at hospital admission on clinician workflow.

    PubMed

    Vawdrey, David K; Chang, Nancy; Compton, Audrey; Tiase, Vicky; Hripcsak, George

    2010-11-13

    Many hospitals have experienced challenges with accomplishing the Joint Commission's National Patient Safety Goal for medication reconciliation. Our institution implemented a fully electronic process for performing and documenting medication reconciliation at hospital admission. The process used a commercial EHR and relied on a longitudinal medication list called the "Outpatient Medication Profile" (OMP). Clinician compliance with documenting medication reconciliation was difficult to achieve, but approached 100% after a "hard-stop" reminder was implemented. We evaluated the impact of the process at a large urban academic medical center. Before the new process was adopted, the average number of medications contained in the OMP for a patient upon admission was <2. One year after adoption, the average number had increased to 4.7, and there were regular updates made to the list. Updating the OMP was predominantly done by physicians, NPs, and PAs (94%), followed by nurses (5%) and pharmacists (1%).

  9. Descriptions of Acute Transfusion Reactions in the Teaching Hospitals of Kermanshah University of Medical Sciences, Iran

    PubMed Central

    Payandeh, Mehrdad; Zare, Mohammad Erfan; Kansestani, Atefeh Nasir; Pakdel, Shirin Falah; Jahanpour, Firuzeh; Yousefi, Hoshang; Soleimanian, Farzaneh

    2013-01-01

    Background Transfusion services rely on transfusion reaction reporting to provide patient care and protect the blood supply. Unnecessary discontinuation of blood is a major wastage of scarce blood, as well as man, hours and funds. The aim of the present study was to describe the main characteristics of acute transfusion reactions reported in the 4 hospital of Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran. Material and Methods The study was carried out at 4 teaching hospital of Kermanshah University of Medical Sciences, Kermanshah, Iran, over18 months from April 2010. All adult patients on admission in the hospitals who required blood transfusion and had establish diagnosis and consented were included in the study. Results In the year 2010 until 2012, a total of 6238 units of blood components were transfused. A total of 59 (0.94%) cases of transfusion reaction were reported within this 3 years period. The commonest were allergic reactions which presented with various skin manifestations such as urticarial, rashes and pruritus (49.2%), followed by increase in body temperature of > 1°C from baseline which was reported as febrile non-hemolytic transfusion reaction (37.2%). pain at the transfusion site (6.8%) and hypotension (6.8%). Conclusion It is important that each transfusion of blood components to be monitor carefully. Many transfusion reactions are not recognized, because signs and symptoms mimic other clinical conditions. Any unexpected symptoms in a transfusion recipient should at least be considered as a possible transfusion reaction and be evaluated. Prompt recognition and treatment of acute transfusion reaction are crucial and would help in decreasing transfusion related morbidity and mortality, but prevention is preferable. PMID:24505522

  10. Abusive Head Trauma in Young Children: Characteristics and Medical Charges in a Hospitalized Population

    ERIC Educational Resources Information Center

    Ettaro, L.; Berger, R. P.; Songer, T.

    2004-01-01

    Objective: To describe the presenting characteristics, hospital course, and hospital charges associated with hospital admissions for head trauma in young children at a regional pediatric trauma center, and to examine whether these factors differ among abused and non-abused subjects. Method: Comparative case series study involving a retrospective…

  11. Abusive Head Trauma in Young Children: Characteristics and Medical Charges in a Hospitalized Population

    ERIC Educational Resources Information Center

    Ettaro, L.; Berger, R. P.; Songer, T.

    2004-01-01

    Objective: To describe the presenting characteristics, hospital course, and hospital charges associated with hospital admissions for head trauma in young children at a regional pediatric trauma center, and to examine whether these factors differ among abused and non-abused subjects. Method: Comparative case series study involving a retrospective…

  12. Strategies Nurse Managers Used to Offset Challenges during Electronic Medical Records Implementation: A Case Study

    ERIC Educational Resources Information Center

    Easterling, Latasha

    2015-01-01

    The purpose of this qualitative, descriptive case study was to discover successful approaches used, by nurse managers, to reduce barriers during the implementation of electronic medical record system in one hospital. Fourteen nurse managers were interviewed from an academic health science center in Mississippi. A pilot study was conducted to…

  13. Strategies Nurse Managers Used to Offset Challenges during Electronic Medical Records Implementation: A Case Study

    ERIC Educational Resources Information Center

    Easterling, Latasha

    2015-01-01

    The purpose of this qualitative, descriptive case study was to discover successful approaches used, by nurse managers, to reduce barriers during the implementation of electronic medical record system in one hospital. Fourteen nurse managers were interviewed from an academic health science center in Mississippi. A pilot study was conducted to…

  14. [Advocacy and early discharge under the new system of hospitalization for medical care and protection].

    PubMed

    Otsuka, Atsuko

    2014-01-01

    The Act on Mental Health and Welfare for the Mentally Disabled was partially amended during the 183rd ordinary session of the Diet, on June 13, 2013. The revision abolished the system of guardianship that had long imposed conflicting roles on families of people with mental disorders. Various issues and concerns remain, however, including the requirement that consent for hospitalization be provided by a family member. Many people who need involuntary hospitalization find themselves in situations where it is difficult to continue living in the community. At the time of hospital admission, along with a medical examination, it is necessary to assess the patient's support system in the community and ascertain whether "hospitalization for medical care and protection" is, in fact, the only option. When hospitalization for medical care and protection is determined to be unavoidable, treatment and planning focused on early discharge and the patient's return to life in the community should be initiated immediately after hospitalization. Actual patient outcomes clearly indicate that early discharge is often the result when medical institutions collaborate and network with multidisciplinary teams and community support workers immediately after hospitalization. It is hoped that the amended law will have a practical impact that will result in similar outcomes throughout the nation in the future. At the same' time, it is crucial to expand staffing in medical institutions, foster a culture of team treatment, and promote the creation of better community mental health systems that include housing, social resources, and family support.

  15. Development of a Hospital-based Massage Therapy Course at an Academic Medical Center

    PubMed Central

    Dion, Liza J.; Cutshall, Susanne M.; Rodgers, Nancy J.; Hauschulz, Jennifer L.; Dreyer, Nikol E.; Thomley, Barbara S.; Bauer, Brent

    2015-01-01

    Background: Massage therapy is offered increasingly in US medical facilities. Although the United States has many massage schools, their education differs, along with licensure and standards. As massage therapy in hospitals expands and proves its value, massage therapists need increased training and skills in working with patients who have various complex medical concerns, to provide safe and effective treatment. These services for hospitalized patients can impact patient experience substantially and provide additional treatment options for pain and anxiety, among other symptoms. The present article summarizes the initial development and description of a hospital-based massage therapy course at a Midwest medical center. Methods: A hospital-based massage therapy course was developed on the basis of clinical experience and knowledge from massage therapists working in the complex medical environment. This massage therapy course had three components in its educational experience: online learning, classroom study, and a 25-hr shadowing experience. The in-classroom study portion included an entire day in the simulation center. Results: The hospital-based massage therapy course addressed the educational needs of therapists transitioning to work with interdisciplinary medical teams and with patients who have complicated medical conditions. Feedback from students in the course indicated key learning opportunities and additional content that are needed to address the knowledge and skills necessary when providing massage therapy in a complex medical environment. Conclusions: The complexity of care in medical settings is increasing while the length of hospital stay is decreasing. For this reason, massage provided in the hospital requires more specialized training to work in these environments. This course provides an example initial step in how to address some of the educational needs of therapists who are transitioning to working in the complex medical environment. PMID

  16. [Hospital-based health technology assessment in France: how to proceed to evaluate innovative medical devices?].

    PubMed

    Martelli, N; van den Brink, H; Denies, F; Dervaux, B; Germe, A F; Prognon, P; Pineau, J

    2014-01-01

    Innovative medical devices offer solutions to medical problems and greatly improve patients' outcomes. Like National Health Technology Assessment (HTA) agencies, hospitals face numerous requests for innovative and costly medical devices. To help local decision-makers, different approaches of hospital-based HTA (HB-HTA) have been adopted worldwide. The objective of the present paper is to explore HB-HTA models for adopting innovative medical devices in France and elsewhere. Four different models have been conceptualized: "ambassador" model, "mini-HTA" model, "HTA unit" model and "internal committee". Apparently, "HTA unit" and "internal committee" (or a mixture of both models) are the prevailing HB-HTA models in France. Nevertheless, some weaknesses of these models have been pointed out in previous works. Only few examples involving hospital pharmacists have been found abroad, except in France and in Italy. Finally, the harmonization of the assessment of innovative medical devices in France needs a better understanding of HB-HTA practices.

  17. Social dynamics in rural Sri Lankan hospitals: revelations from self-poisoning cases.

    PubMed

    Senarathna, Lalith; Hunter, Cynthia; Dawson, Andrew H; Dibley, Michael J

    2013-11-01

    Different hospitals produce different cultures-products of relationships between people of different staff categories and people from external community groups. These relationships demonstrate unique social dynamics in rural peripheral hospitals that form a major part of the health care system in Sri Lanka and other developing countries. Understanding the existing social dynamics might be useful when trying to implement new treatment guidelines that can involve behavior change. We aimed to explore the existing social dynamics in peripheral hospitals in rural Sri Lanka by examining the treatment related to cases of acute self-poisoning that is a common, highly interactive medical emergency. These hospitals demonstrate higher levels of community influence in treatment decisions and closer interactions between hospital staff. We argue that health care teamwork is effective in peripheral hospitals, resulting in benefits to all staff, who see these hospitals as better places to work and train, in contrast to a commonly held belief that such rural hospitals are disadvantaged and difficult places.

  18. The Case Presentation: Teaching Medical Students Writing and Communication Skills.

    ERIC Educational Resources Information Center

    Greenberg, Larrie W.; Jewett, Leslie S.

    1987-01-01

    Described is a program at Childrens Hospital National Medical Center in which the focus is on improving medical students' writing and communication skills as part of a pediatric clerkship. Based on the quality of students' performance and their evaluation of the exercise, this has been a successful innovation. (Author/RH)

  19. Tasks completed by nursing members of a teaching hospital Medical Emergency Team.

    PubMed

    Topple, Michelle; Ryan, Brooke; Baldwin, Ian; McKay, Richard; Blythe, Damien; Rogan, John; Radford, Sam; Jones, Daryl

    2016-02-01

    To assess tasks completed by intensive care medical emergency team nurses. Prospective observational study. Australian teaching hospital. Nursing-related technical and non-technical tasks and level of self-reported confidence and competence. Amongst 400 calls, triggers and nursing tasks were captured in 93.5% and 77.3% of cases, respectively. The median patient age was 73 years. The four most common triggers were hypotension (22.0%), tachycardia (21.1%), low SpO2 (17.4%), and altered conscious state (10.1%). Non-technical skills included investigation review (33.7%), history acquisition (18.4%), contribution to the management plan (40.5%) and explanation to bedside nurses (78.3%), doctors (13.6%), allied health (3.9%) or patient/relative (39.5%). Technical tasks included examining the circulation (32%), conscious state (29.4%), and chest (26.5%). Additional tasks included adjusting oxygen (23.9%), humidification (8.4%), non-invasive ventilation (6.5%), performing an ECG (22%), and administrating fluid as a bolus (17.5%) or maintenance (16, 5.2%), or medication as a statim dose (16.8%) or infusion (5.2%). Self-reported competence and confidence appeared to be high overall amongst our MET nurses. Our findings provide important information on the tasks completed by Medical Emergency Team nurses and will guide future training. Copyright © 2015 Elsevier Ltd. All rights reserved.

  20. The liability of the hospital librarian. Why you need a professional medical librarian.

    PubMed

    Herin, N J

    1991-01-01

    Would you hire a cashier instead of a qualified accountant to manage your hospital's financial department? Certainly not--the stakes are too high. The same test holds for your hospital library: Besides running the risk of possible liability and embarrassment for your hospital, hiring an untrained person to manage your library would not serve the best interests of your medical staff and--most importantly--your patients.

  1. Decentralization and Hospital Pharmacy Services: The Case of Iranian University Affilliated Hospitals

    PubMed Central

    Ashna Delkhosh, Reza; Ardama, Ali; Salamzadeh, Jamshid

    2013-01-01

    The aim of this study was to evaluate the satisfaction rate of hospital managerial/clinical teams (HMCTs) including principles (chief executives), managers, supervisor pharmacists and head nurses from services presented by private sectors directing 10 pharmacy departments in hospitals affiliated to Shahid Beheshti University of Medical Sciences. This study is an observational and descriptive study in which a questionnaire containing 16 questions evaluating the satisfaction of the HMCTs from private sectors, and questions about demography of the responders was used for data collection. Collected data was applied to assign a satisfaction score (maximum 64) for each respondent. SPSS 17.0 and Microsoft Office Excel 2007 were used for statistical description and analysis of these information (where applicable). Overall, 97 people in charge of the hospitals (HMCTs) entered the study. The average satisfaction score was 26.38 ± 6.81 with the lowest satisfaction rate observed in Mofid children specialty hospital (19.5%) and the highest rate obtained for Imam Hussein (p.b.u.h) general hospital (65.3%). Generally, 59% of the HMCTs believed that the function of the private sector in the pharmacy of hospitals is satisfactory. Assuming that the satisfaction scores under 75% of the total obtainable score (i.e. 48 out of 64) could not be considered as an indicator of desired pharmacy services, our results revealed that the status of the services offered by private sectors are far behind the desired satisfactory level. PMID:24250687

  2. Positive correlation between regional emergency medical resources and mortality in severely injured patients: results from the Korean National Hospital Discharge In-depth Survey.

    PubMed

    Lee, Hyo Jung; Ju, Yeong Jun; Park, Eun-Cheol

    2016-12-15

    In South Korea, injury is a public health problem due to its high incidence and high mortality. To improve emergency medical systems, the government announced plans to increase the emergency medical resources for each region. This study investigated the association between regional emergency medical resources and mortality during hospitalization in severely injured inpatients. To analyse mortality for severely injured inpatients, we used the Korean National Hospital Discharge In-depth Survey data, consisting of 18,621 hospitalizations from 2005-2012. Generalized estimating equations were analysed to examine the association between mortality during hospitalization and both individual and regional variables. Mortality during hospitalization occurred in 913 (4.9%) cases. Patients in regions with a higher number of emergency departments (odds ratio [OR]=0.94, 95% confidence interval [CI]: 0.91-0.98), a higher number of ambulances (OR=0.99, 95% CI: 0.98-0.99), and a higher number of registered nurses per emergency department (OR=0.88, 95% CI: 0.83-0.94) had a lower risk of mortality during hospitalization. Our findings suggest that regional emergency medical resources are associated with a lower risk of mortality during hospitalization in severely injured patients. Thus, health care policymakers need to determine the proper distribution of emergency medical resources for each region and the function of emergency departments to provide a superior quality of emergency medical services to patients.

  3. Errors in medication history at hospital admission: prevalence and predicting factors.

    PubMed

    Hellström, Lina M; Bondesson, Åsa; Höglund, Peter; Eriksson, Tommy

    2012-04-03

    An accurate medication list at hospital admission is essential for the evaluation and further treatment of patients. The objective of this study was to describe the frequency, type and predictors of errors in medication history, and to evaluate the extent to which standard care corrects these errors. A descriptive study was carried out in two medical wards in a Swedish hospital using Lund Integrated Medicines Management (LIMM)-based medication reconciliation. A clinical pharmacist identified each patient's most accurate pre-admission medication list by conducting a medication reconciliation process shortly after admission. This list was then compared with the patient's medication list in the hospital medical records. Addition or withdrawal of a drug or changes to the dose or dosage form in the hospital medication list were considered medication discrepancies. Medication discrepancies for which no clinical reason could be identified (unintentional changes) were considered medication history errors. The final study population comprised 670 of 818 eligible patients. At least one medication history error was identified by pharmacists conducting medication reconciliations for 313 of these patients (47%; 95% CI 43-51%). The most common medication error was an omitted drug, followed by a wrong dose. Multivariate logistic regression analysis showed that a higher number of drugs at admission (odds ratio [OR] per 1 drug increase = 1.10; 95% CI 1.06-1.14; p < 0.0001) and the patient living in their own home without any care services (OR = 1.58; 95% CI 1.02-2.45; p = 0.042) were predictors for medication history errors at admission. The results further indicated that standard care by non-pharmacist ward staff had partly corrected the errors in affected patients by four days after admission, but a considerable proportion of the errors made in the initial medication history at admission remained undetected by standard care (OR for medication errors detected by pharmacists

  4. Errors in medication history at hospital admission: prevalence and predicting factors

    PubMed Central

    2012-01-01

    Background An accurate medication list at hospital admission is essential for the evaluation and further treatment of patients. The objective of this study was to describe the frequency, type and predictors of errors in medication history, and to evaluate the extent to which standard care corrects these errors. Methods A descriptive study was carried out in two medical wards in a Swedish hospital using Lund Integrated Medicines Management (LIMM)-based medication reconciliation. A clinical pharmacist identified each patient's most accurate pre-admission medication list by conducting a medication reconciliation process shortly after admission. This list was then compared with the patient's medication list in the hospital medical records. Addition or withdrawal of a drug or changes to the dose or dosage form in the hospital medication list were considered medication discrepancies. Medication discrepancies for which no clinical reason could be identified (unintentional changes) were considered medication history errors. Results The final study population comprised 670 of 818 eligible patients. At least one medication history error was identified by pharmacists conducting medication reconciliations for 313 of these patients (47%; 95% CI 43-51%). The most common medication error was an omitted drug, followed by a wrong dose. Multivariate logistic regression analysis showed that a higher number of drugs at admission (odds ratio [OR] per 1 drug increase = 1.10; 95% CI 1.06-1.14; p < 0.0001) and the patient living in their own home without any care services (OR = 1.58; 95% CI 1.02-2.45; p = 0.042) were predictors for medication history errors at admission. The results further indicated that standard care by non-pharmacist ward staff had partly corrected the errors in affected patients by four days after admission, but a considerable proportion of the errors made in the initial medication history at admission remained undetected by standard care (OR for medication errors

  5. Consultant evaluation of a hospital medication system: synthesis of a new system.

    PubMed

    Barker, K N; Harris, J A; Webster, D B; Stringer, J F; Pearson, R E; Mikeal, R L; Glotzhober, G R; Miller, G J

    1984-10-01

    Recommendations of consultants for the implementation of a new medication system at a large teaching hospital are described. Based on a previous analysis of the hospital's existing drug distribution and control system that revealed problems in reliability and response time, an interdisciplinary consultant group offered 14 recommendations, which included implementation of a computerized unit dose delivery system and selected clinical pharmacy services. Functions identified for which computerization would produce the greatest benefits included maintenance of patient census data, medication order entry and retrieval, and preparation of a medication administration record for nursing. Recommendations for improving the unit dose system in the hospital consisted of increasing the number of medications packaged in true unit dose form, increasing the frequency of daily deliveries of scheduled medications, sending p.r.n. medications on an on-call basis, decreasing the lead time for preparation of i.v. solutions, and using a pharmacist-manned portable medication cart to reduce workload on the central pharmacy during peak workload periods. Clinical pharmacy services identified as having the greatest cost-benefit ratio were discharge consults, drug therapy monitoring, and drug-use review. Using information from published studies and cost data from the hospital, a net annual savings of over +152,000 was projected with implementation of these services. Improvements in the unit dose system and implementation of clinical pharmacy services were expected to result in substantial cost savings in the study hospital.

  6. Strategies to Reduce Hospitalizations of Children With Medical Complexity Through Complex Care: Expert Perspectives.

    PubMed

    Coller, Ryan J; Nelson, Bergen B; Klitzner, Thomas S; Saenz, Adrianna A; Shekelle, Paul G; Lerner, Carlos F; Chung, Paul J

    Interventions to reduce disproportionate hospital use among children with medical complexity (CMC) are needed. We conducted a rigorous, structured process to develop intervention strategies aiming to reduce hospitalizations within a complex care program population. A complex care medical home program used 1) semistructured interviews of caregivers of CMC experiencing acute, unscheduled hospitalizations and 2) literature review on preventing hospitalizations among CMC to develop key drivers for lowering hospital utilization and link them with intervention strategies. Using an adapted version of the RAND/UCLA Appropriateness Method, an expert panel rated each model for effectiveness at impacting each key driver and ultimately reducing hospitalizations. The complex care program applied these findings to select a final set of feasible intervention strategies for implementation. Intervention strategies focused on expanding access to familiar providers, enhancing general or technical caregiver knowledge and skill, creating specific and proactive crisis or contingency plans, and improving transitions between hospital and home. Activities aimed to facilitate family-centered, flexible implementation and consideration of all of the child's environments, including school and while traveling. Tailored activities and special attention to the highest utilizing subset of CMC were also critical for these interventions. A set of intervention strategies to reduce hospitalizations among CMC, informed by key drivers, can be created through a structured, reproducible process. Both this process and the results may be relevant to clinical programs and researchers aiming to reduce hospital utilization through the medical home for CMC. Copyright © 2017 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  7. Evaluation of Electromagnetic Fields in a Hospital for Safe Use of Electronic Medical Equipment.

    PubMed

    Ishida, Kai; Fujioka, Tomomi; Endo, Tetsuo; Hosokawa, Ren; Fujisaki, Tetsushi; Yoshino, Ryoji; Hirose, Minoru

    2016-03-01

    Establishment of electromagnetic compatibility is important in use of electronic medical equipment in hospitals. To evaluate the electromagnetic environment, the electric field intensity induced by electromagnetic radiation in broadcasting spectra coming from outside the hospital was measured in a new hospital building before any patients visited the hospital and 6 months after the opening of the hospital. Various incoming radio waves were detected on the upper floors, with no significant difference in measured levels before and after opening of the hospital. There were no cellphone terminal signals before the hospital opened, but these signals were strongly detected at 6 months thereafter. Cellphone base stations signals were strongly detected on the upper floors, but there were no signals at most locations in the basement and in the center of the building on the lower floors. A maximum electrical intensity of 0.28 V/m from cellphone base stations (2.1 GHz) was detected at the south end of the 2nd floor before the hospital opened. This value is lower than the EMC marginal value for general electronic medical equipment specified in IEC 60601-1-2 (3 V/m). Therefore, electromagnetic interference with electronic medical equipment is unlikely in this situation. However, cellphone terminal signals were frequently detected in non-base station signal areas. This is a concern, and understanding signal strength from cellphone base stations at a hospital is important for promotion of greater safety.

  8. [Microbiologic spectrum and prognostic factors of hospital-acquired pneumonia cases].

    PubMed

    Sevinç, Can; Sahbaz, Sibel; Uysal, Ulker; Kilinç, Oğuz; Ellidokuz, Hülya; Itil, Oya; Gülay, Zeynep; Yunusoğlu, Sedat; Sargun, Serdar; Akkoyun, Kürşat Kaan; Uçan, Eyüp Sabri

    2007-01-01

    Nosocomial infections are an important cause of preventable morbidity and mortality; they also result in significant socioeconomic cost. Nosocomial pneumonia (NCP) is defined as pneumonia, which occurs 48 hours after hospitalization or after discharge from the hospital. It is the second or third most frequent infection among all hospital acquired infections, and the mortality of NCP is higher than the other hospital acquired infections. Patients, diagnosed as NCP were retrospectively analyzed in order to detect microbiological agent and prognostic factors. We evaluated 173 patients, 67.0% of them were male and 33.0% female. Comorbid diseases were present in 94.2% and a medical procedure had been applied in 75.1% of cases. A single agent was isolated in 79.2% of the cases while a mixt infection was present in 13.3%. In 7.5% of the cases, cultures were negative. Endotracheal aspirates were the most common materials (38.9%) used for detected microorganism and sputum cultures were used in 16.8% of the cases. Most commonly encountered microorganism were Pseudomonas aeruginosa, Acinetobacter spp. and Staphylococcus aureus respectively. NCP developed on approximately 18th day of hospitalization. Overall mortality rate was 45.2%. The effects of diabetes mellitus and chronic pulmonary diseases on mortality rate were analized by logistic regression analysis and it's evaluated that the mortality rates increase 3.7 times with diabetes mellitus and 2.4 times with chronic pulmonary diseases. There was no effect of mechanical ventilation history on mortality.

  9. PRN Medication Administration in a Geriatric Psychiatric Hospital: Chart Review and Nursing Perspective.

    PubMed

    Harper, Lori; Reddon, John R; Hunt, Courtney J; Royan, Heather

    2017-03-24

    To improve patient care/outcome, an evaluation was conducted of nursing procedures and protocols for pro re nata (PRN) medications. A 14-day chart review was conducted for 27 patients with mood and thought disorders (MTD) and for 24 patients with organic disorders (OD) at a geriatric psychiatric hospital, and a questionnaire was completed by 20 nurses. 377 PRNs were administered to patients in the MTD and OD units (240 and 137, respectively). The majority of PRNs were administered during the evening shifts on the MTD unit and during the day shifts on the OD unit. Chart notes indicated the behavior requiring PRN administration was not always specifically described and therapeutic interventions were not often attempted before PRN administration. Inconsistency between chart notes and medication record books was noted in the majority of cases. It was often not known whether the PRN was initiated by the staff, patient, or family. PRNs were reported to be not effective in the majority of cases. Documentation was suboptimal and effectiveness was poor. It would be worthwhile to train all staff in a patient-centered or ecopsychosocial (i.e., non-pharmacological) model of care, which would provide staff alternatives to PRNs. In that context, it would be important to implement standards of practice into geriatric psychiatry inpatient settings for PRN administration and documentation.

  10. Complex Case Conferences Associated with Reduced Hospital Admissions for High-Risk Patients with Multiple Comorbidities

    PubMed Central

    Tuso, Philip; Watson, Heather L; Garofalo-Wright, Lynn; Lindsay, Gail; Jackson, Ana; Taitano, Maria; Koyama, Sandra; Kanter, Michael

    2014-01-01

    Objectives: Reducing avoidable hospital readmissions presents an opportunity to improve health care quality and reduce avoidable costs. We studied the effect person-focused care may have on reducing avoidable admissions to the hospital. Methods: Among patients with heart failure discharged from the hospital, we evaluated the effect on 30-day readmissions of transitions-in-care interventions: home health visits, follow-up phone calls, and physician office visits. We also used a standardized diagnostic tool to interview readmitted patients to identify social reasons that may have contributed to the readmission. Finally, we used the learnings from both interventions to develop a new intervention: a single complex disease case conference that included the entire health care team. We measured hospital admissions for 21 patients during the 6 months before and after their complex case conferences. Results: Observed-over-expected hospital readmission rates were lowest for patients receiving a postdischarge visit with a home health nurse and a follow-up visit with their physician (0.54), compared with solely a physician visit (0.81), home health visit (1.2), or phone call (1.55). Various social issues may contribute to hospital readmissions, including caregiver knowledge, ability to care for oneself at home, and issues related to medications (adherence, ability to pay, and knowledge about potential side effects). Substantially fewer hospital admissions occurred after complex case conferences. Conclusions: Complex case conferences with disease-focused and person-focused interventions may be associated with reduced hospital admissions for patients with heart failure and multiple comorbidities. PMID:24626071

  11. Medical Surge Capacity in Atlanta-Area Hospitals in Response to Tanker Truck Chemical Releases.

    PubMed

    Harris, Curtis; Bell, William; Rollor, Edward; Waltz, Tawny; Blackwell, Pam; Dallas, Cham

    2015-12-01

    We designed and conducted a regional full-scale exercise in 2007 to test the ability of Atlanta-area hospitals and community partners to respond to a terrorist attack involving the coordinated release of 2 dangerous chemicals (toluene diisocyanate and parathion) that were being transported through the area by tanker truck. The exercise was designed to facilitate the activation of hospital emergency response plans and to test applicable triage, decontamination, and communications protocols. Plume modeling was conducted by using the Defense Threat Reduction Agency's (DTRA) Hazard Prediction and Assessment Capability (HPAC) V4 program. The scenario went through multiple iterations as exercise planners sought to reduce total injuries to a manageable, but stressful, level for Atlanta's health care infrastructure. Atlanta-area hospitals rapidly performed multiple casualty triage and were able to take in a surge of victims from the simulated attack. However, health care facilities were reticent to push the perceived manageable numbers of victims, and scenarios were modified significantly to lower the magnitude of the simulated attack. Additional coordination with community response partners and incident command training is recommended. Security at health care facilities and decontamination of arriving victims are two areas that will require continued review. Atlanta-area hospitals participated in an innovative regional exercise that pushed facilities beyond traditional scopes of practice and brought together numerous health care community response partners. Using lessons learned from this exercise coupled with subsequent real-world events and training exercises, participants have significantly enhanced preparedness levels and increased the metropolitan region's medical surge capacity in the case of a multiple casualty disaster.

  12. Prevention of venous thromboembolism in hospitalized acutely ill medical patients: focus on the clinical utility of (low-dose) fondaparinux.

    PubMed

    Di Nisio, Marcello; Porreca, Ettore

    2013-01-01

    Venous thromboembolism (VTE) is a frequent complication among acutely ill medical patients hospitalized for congestive heart failure, acute respiratory insufficiency, rheumatologic disorders, and acute infectious and/or inflammatory diseases. Based on robust data from randomized controlled studies and meta-analyses showing a reduced incidence of VTE by 40% to about 60% with pharmacologic thromboprophylaxis, prevention of VTE with low molecular weight heparin (LMWH), unfractionated heparin (UFH), or fondaparinux is currently recommended in all at-risk hospitalized acutely ill medical patients. In patients who are bleeding or are at high risk for major bleeding, mechanical prophylaxis with graduated compression stockings or intermittent pneumatic compression may be suggested. Thromboprophylaxis is generally continued for 6 to 14 days or for the duration of hospitalization. Selected cases could benefit from extended thromboprophylaxis beyond this period, although the risk of major bleeding remains a concern, and additional studies are needed to identify patients who may benefit from prolonged prophylaxis. For hospitalized acutely ill medical patients with renal insufficiency, a low dose (1.5 mg once daily) of fondaparinux or prophylactic LMWH subcutaneously appears to have a safe profile, although proper evaluation in randomized studies is lacking. The evidence on the use of prophylaxis for VTE in this latter group of patients, as well as in those at higher risk of bleeding complications, such as patients with thrombocytopenia, remains scarce. For critically ill patients hospitalized in intensive care units with no contraindications, LMWH or UFH are recommended, with frequent and careful assessment of the risk of bleeding. In this review, we discuss the evidence for use of thromboprophylaxis for VTE in acutely ill hospitalized medical patients, with a focus on (low-dose) fondaparinux.

  13. The European Federation of Organisations for Medical Physics Policy Statement no. 15: recommended guidelines on the role of the Medical Physicist within the hospital governance board.

    PubMed

    Christofides, Stelios; Sharp, Peter

    2015-05-01

    This EFOMP Policy Statement presents an outline on hospital governance and encourages the participation of the Medical Physicist in the hospital governance. It also emphasises how essential it is for Medical Physicists to engage in their hospital's governing board's committees for the overall good of the patient.

  14. Marketing hand hygiene in hospitals--a case study.

    PubMed

    Gopal Rao, G; Jeanes, A; Osman, M; Aylott, C; Green, J

    2002-01-01

    Hand hygiene of healthcare workers is frequently poor despite the efforts of infection control teams to promote hand decontamination as the most important method to prevent transmission of hospital-acquired infections. In this case study, we describe how principles of societal marketing were applied to improve hand hygiene. Pre-marketing analysis of strengths, weaknesses, opportunities and threats to implementation; attention to product, price, promotion and placement; and post-marketing 'customer' surveys were the essential components of the marketing strategy and its implementation. Placement of an alcohol-based gel decontaminant (Spirigel) at the bedside of every patient was widely welcomed in the hospital, and has played a major role in improving hand hygiene of healthcare workers. In the twelve months following the implementation, the decontaminant was used at least 440,000 times. The cost of purchasing the decontaminant was approximately 5000 pounds sterling. Following the introduction of Spirigel, there was a consistent reduction in the proportion of hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) in each of the quarters of 2000-2001 compared with 1999-2000. In the period 1999-2000, nearly 50% of the MRSA were hospital acquired compared with 39% in 2000-2001. Similarly, the average incidence of Clostridium difficile associated diarrhoea (CDAD) decreased in each of the quarters in 2000-2001 following the introduction of Spirigel. During this period, there was an average incidence of 9.5 cases of CDAD/1000 admissions compared with 11.5 cases of CDAD/1000 admissions in 1999-2000. This represents a 17.4% reduction in the incidence of CDAD. However, this reduction was not statistically significant (P=0.2). Our case study demonstrates that principles of societal marketing methods can be used effectively to promote and sustain hand hygiene in hospitals. Improvement in hand hygiene will lead to considerable reduction in hospital

  15. Television Medical Dramas as Case Studies in Biochemistry

    ERIC Educational Resources Information Center

    Millard, Julie T.

    2009-01-01

    Several case studies from popular television medical dramas are described for use in an undergraduate biochemistry course. These cases, which illustrate fundamental principles of biochemistry, are used as the basis for problems that can be discussed further in small groups. Medical cases provide an interesting context for biochemistry with video…

  16. Television Medical Dramas as Case Studies in Biochemistry

    ERIC Educational Resources Information Center

    Millard, Julie T.

    2009-01-01

    Several case studies from popular television medical dramas are described for use in an undergraduate biochemistry course. These cases, which illustrate fundamental principles of biochemistry, are used as the basis for problems that can be discussed further in small groups. Medical cases provide an interesting context for biochemistry with video…

  17. Workload Impact of Medical Subspecialties in the Teaching Hospital

    ERIC Educational Resources Information Center

    Van Peenen, Hubert J.

    1973-01-01

    This paper documents, using a single test as a model, the significant increase in clinical laboratory workload which occurred in a university hospital when strong sections of nephrology, hematology-oncology, and immunology-rheumatology were added to the department of medicine. (Author)

  18. Workload Impact of Medical Subspecialties in the Teaching Hospital

    ERIC Educational Resources Information Center

    Van Peenen, Hubert J.

    1973-01-01

    This paper documents, using a single test as a model, the significant increase in clinical laboratory workload which occurred in a university hospital when strong sections of nephrology, hematology-oncology, and immunology-rheumatology were added to the department of medicine. (Author)

  19. Effect of a pharmacist intervention on clinically important medication errors after hospital discharge: a randomized trial.

    PubMed

    Kripalani, Sunil; Roumie, Christianne L; Dalal, Anuj K; Cawthon, Courtney; Businger, Alexandra; Eden, Svetlana K; Shintani, Ayumi; Sponsler, Kelly Cunningham; Harris, L Jeff; Theobald, Cecelia; Huang, Robert L; Scheurer, Danielle; Hunt, Susan; Jacobson, Terry A; Rask, Kimberly J; Vaccarino, Viola; Gandhi, Tejal K; Bates, David W; Williams, Mark V; Schnipper, Jeffrey L

    2012-07-03

    Clinically important medication errors are common after hospital discharge. They include preventable or ameliorable adverse drug events (ADEs), as well as medication discrepancies or nonadherence with high potential for future harm (potential ADEs). To determine the effect of a tailored intervention on the occurrence of clinically important medication errors after hospital discharge. Randomized, controlled trial with concealed allocation and blinded outcome assessors. (ClinicalTrials.gov registration number: NCT00632021) Two tertiary care academic hospitals. Adults hospitalized with acute coronary syndromes or acute decompensated heart failure. Pharmacist-assisted medication reconciliation, inpatient pharmacist counseling, low-literacy adherence aids, and individualized telephone follow-up after discharge. The primary outcome was the number of clinically important medication errors per patient during the first 30 days after hospital discharge. Secondary outcomes included preventable or ameliorable ADEs, as well as potential ADEs. Among 851 participants, 432 (50.8%) had 1 or more clinically important medication errors; 22.9% of such errors were judged to be serious and 1.8% life-threatening. Adverse drug events occurred in 258 patients (30.3%) and potential ADEs in 253 patients (29.7%). The intervention did not significantly alter the per-patient number of clinically important medication errors (unadjusted incidence rate ratio, 0.92 [95% CI, 0.77 to 1.10]) or ADEs (unadjusted incidence rate ratio, 1.09 [CI, 0.86 to 1.39]). Patients in the intervention group tended to have fewer potential ADEs (unadjusted incidence rate ratio, 0.80 [CI, 0.61 to 1.04]). The characteristics of the study hospitals and participants may limit generalizability. Clinically important medication errors were present among one half of patients after hospital discharge and were not significantly reduced by a health-literacy-sensitive, pharmacist-delivered intervention. National Heart, Lung, and

  20. New hospital payment systems: comparing medical strategies in The Netherlands, Germany and England.

    PubMed

    van Essen, Anne Marije

    2009-01-01

    This paper seeks to identify different medical strategies adopted in relation to the new hospital payment systems in Germany, The Netherlands and England and analyse how the medical strategies have impacted on the emergence of these New Public Management policy tools between 2002 and 2007. A comparative approach is applied. In addition to secondary sources, the study uses publications in professional journals, official publications of the (national) physician organisations and a (non-random) expert questionnaire to obtain the views of the medical corporate bodies in the three countries. The results reveal differences in the medical strategies in the three countries that point towards the significance of institutional and interest configurations. The Dutch corporate medical body was most willing to solve the conflict, while the German and English corporate medical bodies seem to be keen to use a strategy of confrontation. The differences in medical strategies also impact on the ways in which hospital payment systems have emerged in the three countries. Further research is necessary to study the medical strategies in healthcare reforms from a broader perspective, for instance by including other countries. The paper gives insights into the interplay between the medical profession and the government in the context of new managerial governance practices in the hospital sector. It adds to the scholarly debates about the role of the medical profession in health policy-making.

  1. The microbial etiologies of diarrhea in hospitalized patients from the Puerto Rico Medical Center Hospitals.

    PubMed

    Carrer, Mildred; Vázquez, Guillermo J; Lebrón, Rafael I; Mercado, Xiomara; Martínez, Idalí; Vázquez, Carmen O; Santé, Maria; Robledo, Iraida E

    2005-03-01

    The development of diarrhea in hospitalized patients is a frequently encountered clinical problem, which may be due to infectious or non-infectious causes. The purpose of this study was to identify which common community enteric pathogens, if any, are responsible for diarrheal episodes in hospitalized patients. Stool samples from 76 consecutive, hospitalized patients were analyzed utilizing routine bacterial cultures, smears for identification of ova and parasites and Enzyme-Link Immunoadsorbent Assay (ELISA) for enteric bacteria, parasites and viruses. The results obtained demonstrated that the usual community enteric pathogens were not identified as a major cause of nosocomial diarrhea. In hospital-acquired diarrhea, Clostridium difficile toxins assay was the only clinically significant test in the evaluation of these patients. As a result of this study a guideline for the management of this condition in hospitalized patients is presented.

  2. Evaluation of STAT medication ordering process in a community hospital

    PubMed Central

    Walsh., Kim; Schwartz., Barbara

    Background: In most health care facilities, problems related to delays in STAT medication order processing time are of common concern. Objective: The purpose of this study was to evaluate processing time for STAT orders at Kimball Medical Center. Methods: All STAT orders were reviewed to determine processing time; order processing time was also stratified by physician order entry (physician entered (PE) orders vs. non-physician entered (NPE) orders). Collected data included medication ordered, indication, time ordered, time verified by pharmacist, time sent from pharmacy, and time charted as given to the patient. Results: A total of 502 STAT orders were reviewed and 389 orders were included for analysis. Overall, median time was 29 minutes, IQR 16–63; p<0.0001.). The time needed to process NPE orders was significantly less than that needed for PE orders (median 27 vs. 34 minutes; p=0.026). In terms of NPE orders, the median total time required to process STAT orders for medications available in the Automated Dispensing Devices (ADM) was within 30 minutes, while that required to process orders for medications not available in the ADM was significantly greater than 30 minutes. For PE orders, the median total time required to process orders for medications available in the ADM (i.e., not requiring pharmacy involvement) was significantly greater than 30 minutes. [Median time = 34 minutes (p<0.001)]. Conclusion: We conclude that STAT order processing time may be improved by increasing the availability of medications in ADM, and pharmacy involvement in the verification process. PMID:27382418

  3. A hospital as victim and responder: the Sepulveda VA Medical Center and the Northridge earthquake.

    PubMed

    Chavez, C W; Binder, B

    1996-01-01

    Many hospital emergency plans focus on the hospital as a disaster responder, with a fully operational medical facility, able to receive and treat mass casualties from a clearly defined accident scene. However, hospitals need to prepare a response for extreme casualty events such as earthquakes, tornadoes, or hurricanes. This article describes the planning, mitigation, response, and recovery of a major medical--surgical center thrust into a victim responder role following the devastating Northridge earthquake. The subsequent evacuation and care of patients, treatment of casualties, incident command, prior education and training, and recovery issues are addressed.

  4. [Prevalence of depressive symptoms in hospitalized elderly medical patients].

    PubMed

    Conde Martel, Alicia; Hemmersbach-Miller, Marion; Anía Lafuente, Basilio J; Sujanani Afonso, Natacha; Serrano-Fuentes, Miriam

    2013-01-01

    Depressive symptoms in hospitalized patients are very common, and they have been related to higher mortality. The aim of the study was to estimate the prevalence of depressive symptoms in hospitalized elderly patients and its relationship to various diseases, as well as their functional and mental status and mortality. A total of 115 patients over 64 years of age were prospectively studied. The validated Spanish version of the Geriatric Depression Scale of Yesavage (15-item version) was used. Patients were considered to have depressive symptoms if ≥6 points were obtained. The demographic characteristics, the Charlson comorbidity index, the diagnosis at admission, the functional status assessed by the Barthel and Lawton-Brodie index, the mental capacity assessed by the Pfeiffer questionnaire, the length of the hospital stay, and hospital mortality were recorded. Out of the 115 patients studied, with a mean age of 70.5 years, 71 (61.7%) were female. Depressive symptoms were observed in 46 patients (40%, 95% CI:34.8-43.9). Patients who died showed a significantly higher score on the Yesavage scale (P=.04). The multivariate analysis showed a significantly independent association between depressive symptoms and functional capacity (P=.026), mental status (P=.021), renal failure (P=.001), liver disease (P=.018), and osteoarthritis (P=.017), but losing the previously seen significant association with diabetes (P=.43). The prevalence of depressive symptoms in hospitalized elderly patients is high, and is associated with the diagnoses of renal failure, liver disease and osteoarthritis, with a higher comorbidity and especially with a poorer functional capacity. Copyright © 2012 SEGG. Published by Elsevier Espana. All rights reserved.

  5. An effective intervention to improve the cleanliness of medical lead clothes in an orthopedic specialized hospital.

    PubMed

    Chen, Lu; Xu, YingJun; Zhang, Fengxia; Yang, Qingfeng; Yuan, Juxiang

    2016-11-01

    Dirty medical lead clothes, contaminated with blood or other infected material, may carry ongoing bioburden, which increase the risk of hospital-acquired infection. In this study, we investigated medical lead clothes contamination levels and assessed the effectiveness of the intervention that was constructed to improve the cleanliness of lead clothes.

  6. Knowledge, Attitude, and Practices regarding Whole Body Donation among Medical Professionals in a Hospital in India

    ERIC Educational Resources Information Center

    Ballala, Kirthinath; Shetty, Avinash; Malpe, Surekha Bhat

    2011-01-01

    Voluntary body donation has become an important source of cadavers for anatomical study and education. The objective of this study was to assess knowledge, attitude, and practice (KAP) regarding whole body donation among medical professionals in a medical institute in India. A cross sectional study was conducted at Kasturba Hospital, Manipal,…

  7. Knowledge, Attitude, and Practices regarding Whole Body Donation among Medical Professionals in a Hospital in India

    ERIC Educational Resources Information Center

    Ballala, Kirthinath; Shetty, Avinash; Malpe, Surekha Bhat

    2011-01-01

    Voluntary body donation has become an important source of cadavers for anatomical study and education. The objective of this study was to assess knowledge, attitude, and practice (KAP) regarding whole body donation among medical professionals in a medical institute in India. A cross sectional study was conducted at Kasturba Hospital, Manipal,…

  8. An optimal painless treatment for early hemorrhoids; our experience in Government Medical College and Hospital

    PubMed Central

    Singal, R; Gupta, S; Dalal, AK; Dalal, U; Attri, AK

    2013-01-01

    Objective - To evaluate the efficacy of Infrared Coagulation Therapy (IRC) for hemorrhoids. IRC is a painless, safe and successful procedure. Place and duration of study - Department of Surgery, Government Medical College and Hospital, Sector-32, Chandigarh, India, from August 2006 to October 2008. The choice of procedure depends on the patient's symptoms, the extent of the hemorrhoidal disease, and the experience of the surgeon along with the availability of the techniques/instruments. Materials and methods - This is a prospective study done from August 2006 to October 2008. Total number of 155 patients was included in the study. Infrared Coagulation Therapy (IRC) was performed through a special designed proctoscope. Patients excluded were with coagulopathy disorders, fissure in ano, and anal ulcers. Results - It is an outpatient Department (OPD), non-surgical, ambulatory, painless and bloodless procedure, without any hospital stay. Early recovery and minimal recurrence of hemorrhoids were noted without any morbidity or mortality. We have studied 155 patients, treated with IRC on OPD basis. Surgery was required in few patients in whom IRC failed or was contraindicated. Out of the total 155 patients, 127 came for follow up. After the 1st sitting of IRC therapy: out of 127; 43 patients got a total relief, mass shrinkage was of > 75% in 57 cases and < 50% in 14 cases. Twenty-eight cases did not come for follow-up. In the 2nd sitting, out of 84/127; 58 patients got a total relief, >75% relief in 15 cases and >50 % relief in 11 patients. In the 3rd sitting out of 26/84 cases: 13 cases got a total relief and 13 cases refused to take the third sitting; however, in 7 cases the hemorrhoidal mass shrank up to 50% after the two sittings. These 14 were operated as there was no relief from bleeding after giving two sittings of IRC. Our opinion is that, in the above 14 cases, the patient might have not followed the instructions properly for dietary habits. Conclusion - IRC is a

  9. [The state of forensic medical expertise of civil cases concerning medical disputes].

    PubMed

    Barinov, E Kh; Romodanovskiĭ, P O

    2013-01-01

    It is concluded that the current state of forensic medical expertise of civil cases concerning disputable issues, such as causing harm to health in medical practice, does not meet the requirements of the relevant legal procedures.

  10. Medical pre-hospital management reduces mortality in severe blunt trauma: a prospective epidemiological study

    PubMed Central

    2011-01-01

    Introduction Severe blunt trauma is a leading cause of premature death and handicap. However, the benefit for the patient of pre-hospital management by emergency physicians remains controversial because it may delay admission to hospital. This study aimed to compare the impact of medical pre-hospital management performed by SMUR (Service Mobile d'Urgences et de Réanimation) with non-medical pre-hospital management provided by fire brigades (non-SMUR) on 30-day mortality. Methods The FIRST (French Intensive care Recorded in Severe Trauma) study is a multicenter cohort study on consecutive patients with severe blunt trauma requiring admission to university hospital intensive care units within the first 72 hours. Initial clinical status, pre-hospital life-sustaining treatments and Injury Severity Scores (ISS) were recorded. The main endpoint was 30-day mortality. Results Among 2,703 patients, 2,513 received medical pre-hospital management from SMUR, and 190 received basic pre-hospital management provided by fire brigades. SMUR patients presented a poorer initial clinical status and higher ISS and were admitted to hospital after a longer delay than non-SMUR patients. The crude 30-day mortality rate was comparable for SMUR and non-SMUR patients (17% and 15% respectively; P = 0.61). After adjustment for initial clinical status and ISS, SMUR care significantly reduced the risk of 30-day mortality (odds ratio (OR): 0.55, 95% CI: 0.32 to 0.94, P = 0.03). Further adjustments for the delay to hospital admission only marginally affected these results. Conclusions This study suggests that SMUR management is associated with a significant reduction in 30-day mortality. The role of careful medical assessment and intensive pre-hospital life-sustaining treatments needs to be assessed in further studies. PMID:21251331

  11. Physician retirement: a case for concern in Canadian hospitals.

    PubMed

    Gillies, J H; Ross, L C

    1984-08-15

    Mandatory retirement is being challenged on the basis of age discrimination, and physicians are not divorced from this social trend. In January 1982 legal precedent was set by the Manitoba Court of Appeal concerning the retirement policy for physicians in Canada. Currently, Canadian hospital bylaws include clauses that require a change in membership status once a physician reaches 65 years of age. The main arguments in favour of this change include easier physician manpower management, ensured public safety and, in some instances, greater productivity. The main arguments against this change include loss of income to physicians, loss of skilled manpower to the profession and adverse effects on the mental and physical health of retiring physicians. In an effort to resolve this conflict some Canadian hospitals are developing strategies for reviewing the specific privileges and responsibilities physicians will retain once they reach age 65. The medical staff of the Victoria General Hospital in Halifax, NS have addressed this issue through their annual reappointment process.

  12. Hospitals and plastics. Dioxin prevention and medical waste incinerators.

    PubMed

    Thornton, J; McCally, M; Orris, P; Weinberg, J

    1996-01-01

    CHLORINATED DIOXINS and related compounds are extremely potent toxic substances, producing effects in humans and animals at extremely low doses. Because these compounds are persistent in the environment and accumulate in the food chain, they are now distributed globally, and every member of the human population is exposed to them, primarily through the food supply and mothers' milk. An emerging body of information suggests that dioxin contamination has reached a level that may pose a large-scale, long-term public health risk. Of particular concern are dioxin's effects on reproduction, development, immune system function, and carcinogenesis. Medical waste incineration is a major source of dioxins. Polyvinyl chloride (PVC) plastic, as the dominant source of organically bound chlorine in the medical waste stream, is the primary cause of "iatrogenic" dioxin produced by the incineration of medical wastes. Health professionals have a responsibility to work to reduce dioxin exposure from medical sources. Health care institutions should implement policies to reduce the use of PVC plastics, thus achieving major reductions in medically related dioxin formation.

  13. Hospitals and plastics. Dioxin prevention and medical waste incinerators.

    PubMed Central

    Thornton, J; McCally, M; Orris, P; Weinberg, J

    1996-01-01

    CHLORINATED DIOXINS and related compounds are extremely potent toxic substances, producing effects in humans and animals at extremely low doses. Because these compounds are persistent in the environment and accumulate in the food chain, they are now distributed globally, and every member of the human population is exposed to them, primarily through the food supply and mothers' milk. An emerging body of information suggests that dioxin contamination has reached a level that may pose a large-scale, long-term public health risk. Of particular concern are dioxin's effects on reproduction, development, immune system function, and carcinogenesis. Medical waste incineration is a major source of dioxins. Polyvinyl chloride (PVC) plastic, as the dominant source of organically bound chlorine in the medical waste stream, is the primary cause of "iatrogenic" dioxin produced by the incineration of medical wastes. Health professionals have a responsibility to work to reduce dioxin exposure from medical sources. Health care institutions should implement policies to reduce the use of PVC plastics, thus achieving major reductions in medically related dioxin formation. Images p298-a p299-a p300-a p301-a p305-a p307-a p310-a PMID:8711095

  14. [Continuity of medical care. Evaluation of a collaborative program between hospital and Primary Care].

    PubMed

    Fernández Moyano, A; García Garmendia, J L; Palmero Palmero, C; García Vargas-Machuca, B; Páez Pinto, J M; Alvarez Alcina, M; Aparicio Santos, R; Benticuaga Martines, M; Delgado de la Cuesta, J; de la Rosa Morales, R; Escorial Moya, C; Espinosa Calleja, R; Fernández Rivera, J; González-Becerra, C; López Herrero, E; Marín Fernández, Y; Mata Martín, A M; Ramos Guerrero, A; Romero Rivero, M J; Sánchez-Dalp, M; Vallejo Maroto, I

    2007-11-01

    The patients being treated in our health care system are becoming increasingly older and have a greater prevalence of chronic diseases. Due to these factors, these patients require greater and easier accessibility to the system as well as continuity of medical care. Collaboration between the different levels of health care has been instrumental in the success of the system and has produced changes in the hospital medical care protocol. Our hospital has developed a care model oriented towards the patient's needs, resulting in a higher grade of satisfaction among the medical professionals. In this paper, we have given a detailed description of part of our medical model, illustrating its different components and indicating several parameters of its evaluation. We have also reviewed the current state of the various models published on this topic. In summary, we believe that this medical care model presents a different approach to management that benefits patients, medical professionals and the health system alike.

  15. Health care in the future may be as close as your neighborhood retail store: the case of Mount Sinai Hospital, Chicago.

    PubMed

    Greenspan, B; Leventhal, R C

    1995-01-01

    The hospital industry nationwide has undergone tremendous changes over the past several years. As a result, hospitals have had to develop new marketing strategies for survival, diversifying their services and seeking new non-hospital sources of revenue. This case study focuses on the successful development of the Family Health Corners, a pair of primary care medical practices sponsored by Mount Sinai Medical Center (Chicago) and located inside Zayre Department Stores.

  16. An investigation Into Traditional Chinese Medicine Hospitals in China: Development Trend and Medical Service Innovation

    PubMed Central

    Wang, Liang; Suo, Sizhuo; Li, Jian; Hu, Yuanjia; Li, Peng; Wang, Yitao; Hu, Hao

    2017-01-01

    Background: This paper aims to investigate the development trend of traditional Chinese medicine (TCM) hospitals in China and explore their medical service innovations, with special reference to the changing co-existence with western medicine (WM) at TCM hospitals. Methods: Quantitative data at macro level was collected from official databases of China Health Statistical Yearbook and Extracts of Traditional Chinese Medicine Statistics. Qualitative data at micro level was gathered through interviews and second-hand material collection at two of the top-level TCM hospitals. Results: In both outpatient and inpatient sectors of TCM hospitals, drug fees accounted for the biggest part of hospital revenue. Application of WM medical exanimation increased in both outpatient and inpatient services. Even though the demand for WM drugs was much higher in inpatient care, TCM drugs was the winner in the outpatient. Also qualitative evidence showed that TCM dominated the outpatient hospital service with WM incorporated in the assisting role. However, it was in the inpatient medical care that WM prevailed over TCM which was mostly applied to the rehabilitation of patients. Conclusion: By drawing on WM while keeping it active in supporting and strengthening the TCM operation in the TCM hospital, the current system accommodates the overriding objective which is for TCM to evolve into a fully informed and more viable medical field. PMID:28005539

  17. An investigation Into Traditional Chinese Medicine Hospitals in China: Development Trend and Medical Service Innovation.

    PubMed

    Wang, Liang; Suo, Sizhuo; Li, Jian; Hu, Yuanjia; Li, Peng; Wang, Yitao; Hu, Hao

    2016-06-07

    This paper aims to investigate the development trend of traditional Chinese medicine (TCM) hospitals in China and explore their medical service innovations, with special reference to the changing co-existence with western medicine (WM) at TCM hospitals. Quantitative data at macro level was collected from official databases of China Health Statistical Yearbook and Extracts of Traditional Chinese Medicine Statistics. Qualitative data at micro level was gathered through interviews and second-hand material collection at two of the top-level TCM hospitals. In both outpatient and inpatient sectors of TCM hospitals, drug fees accounted for the biggest part of hospital revenue. Application of WM medical exanimation increased in both outpatient and inpatient services. Even though the demand for WM drugs was much higher in inpatient care, TCM drugs was the winner in the outpatient. Also qualitative evidence showed that TCM dominated the outpatient hospital service with WM incorporated in the assisting role. However, it was in the inpatient medical care that WM prevailed over TCM which was mostly applied to the rehabilitation of patients. By drawing on WM while keeping it active in supporting and strengthening the TCM operation in the TCM hospital, the current system accommodates the overriding objective which is for TCM to evolve into a fully informed and more viable medical field.

  18. A network collaboration implementing technology to improve medication dispensing and administration in critical access hospitals.

    PubMed

    Wakefield, Douglas S; Ward, Marcia M; Loes, Jean L; O'Brien, John

    2010-01-01

    We report how seven independent critical access hospitals collaborated with a rural referral hospital to standardize workflow policies and procedures while jointly implementing the same health information technologies (HITs) to enhance medication care processes. The study hospitals implemented the same electronic health record, computerized provider order entry, pharmacy information systems, automated dispensing cabinets (ADC), and barcode medication administration systems. We conducted interviews and examined project documents to explore factors underlying the successful implementation of ADC and barcode medication administration across the network hospitals. These included a shared culture of collaboration; strategic sequencing of HIT component implementation; interface among HIT components; strategic placement of ADCs; disciplined use and sharing of workflow analyses linked with HIT applications; planning for workflow efficiencies; acquisition of adequate supply of HIT-related devices; and establishing metrics to monitor HIT use and outcomes.

  19. A network collaboration implementing technology to improve medication dispensing and administration in critical access hospitals

    PubMed Central

    Ward, Marcia M; Loes, Jean L; O'Brien, John

    2010-01-01

    We report how seven independent critical access hospitals collaborated with a rural referral hospital to standardize workflow policies and procedures while jointly implementing the same health information technologies (HITs) to enhance medication care processes. The study hospitals implemented the same electronic health record, computerized provider order entry, pharmacy information systems, automated dispensing cabinets (ADC), and barcode medication administration systems. We conducted interviews and examined project documents to explore factors underlying the successful implementation of ADC and barcode medication administration across the network hospitals. These included a shared culture of collaboration; strategic sequencing of HIT component implementation; interface among HIT components; strategic placement of ADCs; disciplined use and sharing of workflow analyses linked with HIT applications; planning for workflow efficiencies; acquisition of adequate supply of HIT-related devices; and establishing metrics to monitor HIT use and outcomes. PMID:20819868

  20. Prevalence of medication-related problems among patients with renal compromise in an Indian hospital.

    PubMed

    Castelino, R L; Sathvik, B S; Parthasarathi, G; Gurudev, K C; Shetty, M S; Narahari, M G

    2011-08-01

    Patients suffering from renal dysfunction often have multiple medical conditions either as a cause or as a consequence of their renal disease. These patients receive an average of 10-12 medications daily leading to complex dosing schedules and are more likely to develop medication-related problems (MRPs). The objectives of this study were to determine the nature and extent of MRPs in renally compromised patients and to explore the potential clinical significance of the MRPs. The potential for a clinical pharmacist to contribute towards resolving or preventing some of these MRPs was also explored. A prospective study was conducted for a period of 9 months in the renal unit of Jagadguru Shri Shivaratheeshwara (JSS) Medical College Hospital, Mysore, India. Patients undergoing dialysis on outpatient basis and patients who were admitted under the care of or referred to the nephrologists for renal dysfunction from other specialties were reviewed. Patterns of the MRPs were identified using an adapted Hepler and Strand criteria. The potential clinical significance of the MRPs and the contribution of the clinical pharmacist in resolving or minimizing some of the MRPs were also explored. Three hundred and twenty-seven MRPs were identified with 308 patients reviewed. The incidence of MRPs was found to be 1·06 ± 0·85 per patient reviewed. The most common MRP identified in our study was overdose (19·3%) followed by adverse drug reactions (19·0%). Cardiovascular agents (33·6%) followed by anti-infective agents (26·3%) were the most common therapeutic classes of medication implicated in causing MRPs. Twenty-six per cent of the MRPs identified were explored to be potentially moderate or major in clinical significance. The clinical pharmacists' recommendations were accepted in 97% of the cases, which resulted in a change in therapy in 83% of the cases. Medication-related problems are frequent in renally compromised patients in our patient population. The high level of

  1. Medical Record Clerk Training Program, Course of Study; Instructor's Guide: For Medical Record Personnel in Small Rural Hospitals in Colorado.

    ERIC Educational Resources Information Center

    Community Health Service (DHEW/PHS), Arlington, VA. Div. of Health Resources.

    A program of education including training materials is presented to improve the technical proficiency of medical record clerks in small, rural hospitals. The program is planned for fifteen days of instruction or approximately 120 hours including evaluation, orientation and discussion sessions. Students are expected to have a high school diploma…

  2. An Introduction to Emergency Medical Services (EMS). Pre-Hospital Phase. Emergency Medical Services Orientation, Lesson Plan No. 9.

    ERIC Educational Resources Information Center

    Young, Derrick P.

    Designed for use with interested students at high schools, community colleges, and four-year colleges, this lesson plan was developed to provide an introduction to the pre-hospital phase of Emergency Medical Services (EMS) and to serve as a recruitment tool for the EMS Program at Kapiolani Community College (KCC) in Hawaii. The objectives of the…

  3. Medication Adherence and the Risk of Cardiovascular Mortality and Hospitalization Among Patients With Newly Prescribed Antihypertensive Medications.

    PubMed

    Kim, Soyeun; Shin, Dong Wook; Yun, Jae Moon; Hwang, Yunji; Park, Sue K; Ko, Young-Jin; Cho, BeLong

    2016-03-01

    The importance of adherence to antihypertensive treatments for the prevention of cardiovascular disease has not been well elucidated. This study evaluated the effect of antihypertensive medication adherence on specific cardiovascular disease mortality (ischemic heart disease [IHD], cerebral hemorrhage, and cerebral infarction). Our study used data from a 3% sample cohort that was randomly extracted from enrollees of Korean National Health Insurance. Study subjects were aged ≥20 years, were diagnosed with hypertension, and started newly prescribed antihypertensive medication in 2003 to 2004. Adherence to antihypertensive medication was estimated as the cumulative medication adherence. Subjects were divided into good (cumulative medication adherence, ≥80%), intermediate (cumulative medication adherence, 50%-80%), and poor (cumulative medication adherence, <50%) adherence groups. We used time-dependent Cox proportional hazards models to evaluate the association between medication adherence and health outcomes. Among 33 728 eligible subjects, 670 (1.99%) died of coronary heart disease or stroke during follow-up. Patients with poor medication adherence had worse mortality from IHD (hazard ratio, 1.64; 95% confidence interval, 1.16-2.31; P for trend=0.005), cerebral hemorrhage (hazard ratio, 2.19; 95% confidence interval, 1.28-3.77; P for trend=0.004), and cerebral infarction (hazard ratio, 1.92; 95% confidence interval, 1.25-2.96; P for trend=0.003) than those with good adherence. The estimated hazard ratios of hospitalization for cardiovascular disease were consistent with the mortality end point. Poor medication adherence was associated with higher mortality and a greater risk of hospitalization for specific cardiovascular diseases, emphasizing the importance of a monitoring system and strategies to improve medication adherence in clinical practice.

  4. Performance of on-site Medical waste disinfection equipment in hospitals of Tabriz, Iran.

    PubMed

    Taghipour, Hassan; Alizadeh, Mina; Dehghanzadeh, Reza; Farshchian, Mohammad Reza; Ganbari, Mohammad; Shakerkhatibi, Mohammad

    2016-01-01

    Background: The number of studies available on the performance of on-site medical waste treatment facilities is rare, to date. The aim of this study was to evaluate the performance of onsite medical waste treatment equipment in hospitals of Tabriz, Iran. Methods: A various range of the on-site medical waste disinfection equipment (autoclave, chemical disinfection, hydroclave, and dry thermal treatment) was considered to select 10 out of 22 hospitals in Tabriz to be included in the survey. The apparatus were monitored mechanically, chemically, and biologically for a six months period in all of the selected hospitals. Results: The results of the chemical monitoring (Bowie-Dick tests) indicated that 38.9% of the inspected autoclaves had operational problems in pre-vacuum, air leaks, inadequate steam penetration into the waste, and/or vacuum pump. The biological indicators revealed that about 55.55% of the samples were positive. The most of applied devices were not suitable for treating anatomical, pharmaceutical, cytotoxic, and chemical waste. Conclusion: Although on-site medical waste treating facilities have been installed in all the hospitals, the most of infectious-hazardous medical waste generated in the hospitals were deposited into a municipal solid waste landfill, without enough disinfection. The responsible authorities should stringently inspect and evaluate the operation of on-site medical waste treating equipment. An advanced off-site central facility with multi-treatment and disinfection equipment and enough capacity is recommended as an alternative.

  5. Findings from the ISMP Medication Safety Self-Assessment for hospitals.

    PubMed

    Smetzer, Judy L; Vaida, Allen J; Cohen, Michael R; Tranum, Diane; Pittman, Mary A; Armstrong, Carl W

    2003-11-01

    Hospital medication practices should be assessed, awareness of the characteristics of a safe medication system heightened, and baseline data to identify national priorities established. A cross-sectional survey of U.S. hospitals (N = 6,180) was conducted in May 2000. The survey instrument contained 194 self-assessment items organized into 20 core characteristics and 10 larger domains. Hospitals were asked to voluntarily submit their confidential assessment data to the Institute for Safe Medication Practices (ISMP) for aggregate analysis. A weighting structure was applied to the individual items and used to calculate core characteristic scores, domain scores, and overall self-assessment scores. These scores were then compared to identify areas most in need of improvement. The 1,435 participating hospitals scored highest in domains related to drug storage and distribution; environmental factors; infusion pumps; and medication labeling, packaging, and nomenclature issues. These hospitals scored lowest in domains related to accessible patient information, communication of medication orders, patient education, and quality processes such as double-check systems and organizational culture. Enormous opportunities exist to improve medication safety, especially in domains related to culture, information management, and communication.

  6. Performance of on-site Medical waste disinfection equipment in hospitals of Tabriz, Iran

    PubMed Central

    Taghipour, Hassan; Alizadeh, Mina; Dehghanzadeh, Reza; Farshchian, Mohammad Reza; Ganbari, Mohammad; Shakerkhatibi, Mohammad

    2016-01-01

    Background: The number of studies available on the performance of on-site medical waste treatment facilities is rare, to date. The aim of this study was to evaluate the performance of onsite medical waste treatment equipment in hospitals of Tabriz, Iran. Methods: A various range of the on-site medical waste disinfection equipment (autoclave, chemical disinfection, hydroclave, and dry thermal treatment) was considered to select 10 out of 22 hospitals in Tabriz to be included in the survey. The apparatus were monitored mechanically, chemically, and biologically for a six months period in all of the selected hospitals. Results: The results of the chemical monitoring (Bowie-Dick tests) indicated that 38.9% of the inspected autoclaves had operational problems in pre-vacuum, air leaks, inadequate steam penetration into the waste, and/or vacuum pump. The biological indicators revealed that about 55.55% of the samples were positive. The most of applied devices were not suitable for treating anatomical, pharmaceutical, cytotoxic, and chemical waste. Conclusion: Although on-site medical waste treating facilities have been installed in all the hospitals, the most of infectious-hazardous medical waste generated in the hospitals were deposited into a municipal solid waste landfill, without enough disinfection. The responsible authorities should stringently inspect and evaluate the operation of on-site medical waste treating equipment. An advanced off-site central facility with multi-treatment and disinfection equipment and enough capacity is recommended as an alternative. PMID:27766238

  7. Medication problems occurring at hospital discharge among older adults with heart failure.

    PubMed

    Foust, Janice B; Naylor, Mary D; Bixby, M Brian; Ratcliffe, Sarah J

    2012-01-01

    Medication reconciliation problems are common among older adults at hospital discharge and lead to adverse events. The purpose of this study was to examine the rates and types of medication reconciliation problems among older adults hospitalized for acute episodes of heart failure who were discharged home. This secondary analysis of data generated from a transitional care intervention included 198 hospital discharge medical records, representing 162 patients. A retrospective chart review comparing medication lists between hospital discharge summaries and patient discharge instructions was completed to identify medication reconciliation problems. Most hospital discharges (71.2%) had at least one type of reconciliation problem and frequently involved a high-risk medication (76.6%). Discrepancies were the most common problem (58.9%), followed by incomplete discharge summaries (52.5%) and partial patient discharge instructions (48.9%). More attention needs to be given to the quality of discharge instructions, and the problem of vague phrases (e.g., "take as directed") can be addressed by adding it to "do not use" lists to promote safer transitions in care. Copyright 2012, SLACK Incorporated.

  8. Assessment of medical waste management in the main hospitals in Yemen.

    PubMed

    Al-Emad, A A

    2011-10-01

    No previous studies about the management of medical waste have been published in Yemen. This research in 5 government and 12 private hospitals in Sana'a aimed to evaluate waste-workers' and hospital administrators' knowledge and practices regarding medical waste handling. Interviews and observations showedadministrators' knowledge and practices regarding medical waste handling. Interviews and observations showed that the waste-workers were collecting medical and nonmedical wastes together manually in all hospitals without receiving adequate training and without using proper protection equipment. There was poor awareness about medical waste risks and safe handling procedures among hospital administrators, and most hospitals did not differentiate between domestic and medical waste disposal. Budgets were not allocated for waste management purposes, which led to shortages in waste handling equipment and an absence of training programmes for staff. Poor knowledge and practices and a high rate of injuries among waste-workers were noted, together with a risk of exposure of staff and visitors to hazardous waste.

  9. Hospitals as complex adaptive systems: A case study of factors influencing priority setting practices at the hospital level in Kenya.

    PubMed

    Barasa, Edwine W; Molyneux, Sassy; English, Mike; Cleary, Susan

    2017-02-01

    There is a dearth of literature on priority setting and resource allocation (PSRA) practices in hospitals, particularly in low and middle income countries (LMICs). Using a case study approach, we examined PSRA practices in 2 public hospitals in coastal Kenya. We collected data through a combination of in-depth interviews of national level policy makers, hospital managers, and frontline practitioners in the case study hospitals (n = 72), review of documents such as hospital plans and budgets, minutes of meetings and accounting records, and non-participant observations of PSRA practices in case study hospitals over a period of 7 months. In this paper, we apply complex adaptive system (CAS) theory to examine the factors that influence PSRA practices. We found that PSRA practices in the case hospitals were influenced by, 1) inadequate financing level and poorly designed financing arrangements, 2) limited hospital autonomy and decision space, and 3) inadequate management and leadership capacity in the hospital. The case study hospitals exhibited properties of complex adaptive systems (CASs) that exist in a dynamic state with multiple interacting agents. Weaknesses in system 'hardware' (resource scarcity) and 'software' (including PSRA guidelines that reduced hospitals decision space, and poor leadership skills) led to the emergence of undesired properties. The capacity of hospitals to set priorities should be improved across these interacting aspects of the hospital organizational system. Interventions should however recognize that hospitals are CAS. Rather than rectifying isolated aspects of the system, they should endeavor to create conditions for productive emergence.

  10. Cerebrovascular insult hospital cases in West Hercegovina Canton from 1998 to 2002.

    PubMed

    Vasilj, Ivan; Cavaljuga, Semra; Lucić, Tomo; Kvesić, Ferdo

    2005-05-01

    Analysis of a cerebro-vascular insult hospitalised cases from West Herzegovina Canton as a retrospective epidemiological study was done in Clinical hospital Mostar for the period from 1998 to 2002. The major source of data was medical documentation of this hospital, the only hospital for the treatment of 88,257 inhabitants from this Canton. The study included a total of 393 cerebro-vascular insult cases from this Canton treated in the Clinical hospital Mostar. Among them 189 (48.1%) were male patients, while 204 (51.9%) cases were female. The majority of the cases were above 50 years of life. Majority of treated female patients were older then 65, while among male patients the majority were between 50 and 65 years old. The least number of cases was under 50 years in both groups. During the same period risk factors research for entire FBiH was performed on the sample of 2,750 national insurance holders. Out of them 1.7% was found to suffer of cerebro vascular insult.

  11. Influence of social factors on avoidable mortality: a hospital-based case-control study.

    PubMed Central

    Bautista, Daniel; Alfonso, José Luis; Corella, Dolores; Saiz, Carmen

    2005-01-01

    OBJECTIVE: The effect of socioeconomic factors on avoidable mortality at an individual level is not well known, since most studies showing this association are based on aggregate data. The purpose of this study was to determine socioeconomic differences between those patients who die of avoidable causes and those who do not die. METHODS: A matched case-control study was carried out regarding in-hospital avoidable mortality (Holland's medical care indicators) that occurred in a university hospital serving a Spanish-Mediterranean population during a 30-month period. RESULTS: We studied 82 cases of death from avoidable causes and 300 controls matched on medical care indicators and age. The variables that showed a statistically significant association with in-hospital avoidable mortality were number of diagnoses (the greater the number, the higher the risk), length of stay (patients staying seven or more days presented a lower risk), and education. Those patients with low and middle educational levels showed a greater risk of avoidable mortality (adjusted odds ratio=3.57 and 2.82, respectively) than those patients with higher levels of education. CONCLUSIONS: Consistent with the findings of studies based on aggregate data, our case-control analyses indicated that among several socioeconomic variables studied, educational level was significantly associated with the risk of in-hospital avoidable mortality, regardless of age and medical care indicators. Patients with low levels of education (<6 years of schooling) were at highest risk for in-hospital avoidable mortality, followed by those with middle levels of education (7-10 years of schooling). PMID:15736332

  12. Military Medical Revolution: Deployed Hospital and En Route Care

    DTIC Science & Technology

    2012-01-01

    Deployed hospital care DCR Diagnostic evaluation for explosion injury Vascular surgery Ortho wound care Regional anesthesia and TIVA Combat burn care...commonly used topical antimicrobial agents in- clude silver sulfadiazine and sulfamylon cream.51 Newer topical treatment modalities include dressings...more rapid transport of burn casualties from the war zone have resulted in burn survivors with larger wounds requiring coverage. To achieve rapid wound

  13. Cardiac and inflammatory biomarkers and in-hospital mortality in older medical patients.

    PubMed

    Comba, Monica; Fonte, Gianfranco; Isaia, Gianluca; Pricop, Larisa; Sciarrillo, Irene; Michelis, Giuliana; Bo, Mario

    2014-01-01

    Increasing evidence has mounted in recent years on the potential prognostic role of biomarkers out of cardiac-specific medical settings. We aimed to test whether cardiac and inflammatory biomarkers are independently associated with in-hospital mortality in older unselected medical inpatients undergoing standardized multidimensional evaluation. Observational study conducted in a metropolitan university-teaching hospital. A standardized, multidimensional analysis was carried out on all patients by using medical and hospital discharge documentation and interview results integrated with information collected from family members or caregivers. Patients older than 65 years consecutively admitted to the acute geriatric ward and to 2 acute medical wards of the hospital. Male sex; low systolic blood pressure; APACHE score; functional impairment in activities of daily living (ADLs), instrumental ADLs, and Short Physical Performance Battery (SPPB); cognitive impairment; malnutrition; low albumin values; and elevated values of inflammatory and cardiac biomarkers were significantly associated with in-hospital mortality at univariate analysis. After multivariate analysis, male sex, low systolic blood pressure values at entry, severe cognitive impairment, and low functional performance measured by the SPPB resulted to be independently associated with in-hospital mortality. The main finding of the present study is that these biomarkers, although associated with in-hospital mortality, do not have independent predictive significance when a comprehensive and multidimensional evaluation is conducted. The main clinical implication is that our findings should discourage the indiscriminate recourse to measurement of cardiac and inflammatory biomarkers, at least in older medical inpatients, thereby reducing a patient's hospital cost and potentially minimizing further unnecessary diagnostic procedures. Copyright © 2014 American Medical Directors Association, Inc. Published by Elsevier Inc

  14. The completeness of medication histories in hospital medical records of patients admitted to general internal medicine wards

    PubMed Central

    Lau, Hong Sang; Florax, Christa; Porsius, Arijan J; de Boer, Anthonius

    2000-01-01

    Aims Accurate recording of medication histories in hospital medical records (HMR) is important when patients are admitted to the hospital. Lack of registration of drugs can lead to unintended discontinuation of drugs and failure to detect drug related problems. We investigated the comprehensiveness of medication histories in HMR with regard to prescription drugs by comparing the registration of drugs in HMR with computerized pharmacy records obtained from the community pharmacy. Methods Patients admitted to the general ward of two acute care hospitals were included in the study after obtaining informed consent. We conducted an interview on drugs used just prior to hospitalization and extracted the medication history from the HMR. Pharmacy records were collected from the community pharmacists over a 1 year period before the admission. Drugs in the pharmacy records were defined as possibly used (PU-drugs) when they were dispensed before the admission date and had a theoretical enddate of 7 days before the admission date or later. If any PU-drug was not recorded in the HMR, we asked the patient whether they were using that drug or not. Results Data were obtained from 304 patients who had an average age of 71 (range 40–92) years. The total number of drugs according to the HMR was 1239, 43 of which were not used. When compared with the pharmacy records we found an extra 518 drugs that were not recorded in the HMR but were possibly in use. After verification with the patients, 410 of these were indeed in use bringing the total number of drugs in use to 1606. The type of drugs in use but not recorded in the HMR covered a broad spectrum and included many drugs considered to be important such as cardiovascular drugs (n = 67) and NSAIDs (n = 31). The percentages of patients with 0, 1, 2, 3, 4, 5–11 drugs not recorded in the HMR were 39, 28, 16, 8, 3.6 and 5.5, respectively. Of the 1606 drugs in use according to information from all sources, only 38 (2.4%) were not

  15. Opinions of Hospital Pharmacists in Canada Regarding Marijuana for Medical Purposes

    PubMed Central

    Mitchell, Fiona; Gould, Odette; LeBlanc, Michael; Manuel, Leslie

    2016-01-01

    Background: Canada’s most recent Marihuana for Medical Purposes Regulations have changed the way in which patients access marijuana. Furthermore, if authorized by the person in charge of the hospital, a pharmacist practising in a hospital may now place orders with licensed producers for dried marijuana for in-hospital use by patients. As use of this product increases, hospital pharmacists may have an increased role in the care of patients who are using marijuana for medical purposes. Objectives: The primary objective of this study was to determine the opinions of hospital pharmacists in Canada regarding marijuana for medical purposes. The secondary objective was to assess the factors influencing these opinions. Methods: An online survey was made available in early 2015 to licensed hospital pharmacists in Canada through individual provincial and territorial pharmacy regulatory bodies, pharmacist associations, hospital pharmacy directors, the Canadian Society of Hospital Pharmacists, and the Association des pharmaciens des établissements de santé du Québec. Responses were based on a 5-point Likert style scale, ranging from “completely agree” to “completely disagree”. Results: A total of 769 valid survey responses were received. Among the respondents, 44.6% (333/747) agreed that marijuana is safe, whereas 55.2% (411/745) agreed that it is effective. Only 17.2% (129/748) agreed that they were knowledgeable about marijuana for medical purposes, and about 65% of respondents reported no formal training in this area. Factors that influenced respondents’ opinions were age, education, area of clinical practice, province of work, and personal experience. Conclusion: Many Canadian hospital pharmacists agreed that marijuana for medical purposes is safe and effective, yet few considered themselves knowledgeable about this substance, with more than half reporting no formal training on the topic. PMID:27168633

  16. Case five. Development of criteria for hospital acquisition.

    PubMed

    Peterson, A K

    1990-01-01

    The problem explored in this case is the pursuit of horizontal and vertical growth by a multi-institutional system through hospital acquisition. Emphasis is on the selection of appropriate means to identify candidates for acquisition. Since the system did not have extensive experience in formal evaluation of acquisition candidates, it was necessary for system management to develop criteria for acquisition and a process by which to evaluate the criteria. The case is a good example of a thoroughly considered growth orientation.

  17. Effect on clinical work practice of establishing a neonatal intensive care unit at a medical school-affiliated teaching hospital.

    PubMed

    Shima, Yoshio; Migita, Makoto; Asakura, Hirobumi; Takahashi, Tsubasa; Yashiro, Kentaro; Matsumura, Yoshikatsu; Kurokawa, Akira

    2014-01-01

    The aim of this study was to examine the effects of a newly established neonatal intensive care unit (NICU) on clinical work practice and educational activity at Nippon Medical School Musashikosugi Hospital. This retrospective study analyzed the clinical records of all neonates admitted to the NICU from December 2010 through November 2013. Anthropometric data, clinical status, problems, and outcomes of patients and the related obstetrical history were extracted and analyzed. Of the 568 neonatal admissions, about half were related to preterm birth (49%) and low birth weight (55%). Forty-eight percent of patients were born via caesarean delivery. Maternal hypertension, diabetes, and thyroid disease were found in 8%, 5%, and 2% of cases, respectively. Mechanical ventilatory support was provided for 20% of patients. Neonates from multiple pregnancy and with significant congenital anomalies accounted for 17% and 10% of all patients, respectively. Five patients died during hospitalization. In addition training was provided in the NICU for an average of 10 residents and 20 medical students per year. Since the NICU was established, closer cooperation beyond the framework of a single department has come to be needed. In addition, NICUs in teaching hospitals are expected to provide opportunities for medical students and residents to observe and participate in multidisciplinary medical care.

  18. Longitudinal analysis of high-technology medical services and hospital financial performance.

    PubMed

    Zengul, Ferhat D; Weech-Maldonado, Robert; Ozaydin, Bunyamin; Patrician, Patricia A; OʼConnor, Stephen J

    2016-07-27

    U.S. hospitals have been investing in high-technology medical services as a strategy to improve financial performance. Despite the interest in high-tech medical services, there is not much information available about the impact of high-tech services on financial performance. The aim of this study was to examine the impact of high-tech medical services on financial performance of U.S. hospitals by using the resource-based view of the firm as a conceptual framework. Fixed-effects regressions with 2 years lagged independent variables using a longitudinal panel sample of 3,268 hospitals (2005-2010). It was hypothesized that hospitals with rare or large numbers (breadth) of high-tech medical services will experience better financial performance. Fixed effects regression results supported the link between a larger breadth of high-tech services and total margin, but only among not-for-profit hospitals. Both breadth and rareness of high-tech services were associated with high total margin among not-for-profit hospitals. Neither breadth nor rareness of high-tech services was associated with operating margin. Although breadth and rareness of high-tech services resulted in lower expenses per inpatient day among not-for-profit hospitals, these lower costs were offset by lower revenues per inpatient day. Enhancing the breadth of high-tech services may be a legitimate organizational strategy to improve financial performance, especially among not-for-profit hospitals. Hospitals may experience increased productivity and efficiency, and therefore lower inpatient operating costs, as a result of newer technologies. However, the negative impact on operating revenue should caution hospital administrators about revenue reducing features of these technologies, which may be related to the payer mix that these technologies may attract. Therefore, managers should consider both the cost and revenue implications of these technologies.

  19. Trends of increase in western medical services in traditional medicine hospitals in China.

    PubMed

    Shen, Jay J; Wang, Ying; Lin, Fang; Lu, Jun; Moseley, Charles B; Sun, Mei; Hao, Mo

    2011-09-06

    Compare changes in types of hospital service revenues between traditional Chinese medicine (TCM) hospitals and Western-medicine based general hospitals. 97 TCM hospitals and 103 general hospitals were surveyed in years of 2000 and 2004. Six types of medical service revenue between the two types of hospitals were compared overtime. The national statistics from 1999 to 2008 were also used as complementary evidence. For TCM hospitals, the percentage of service revenue from Western medicine increased from 44.3% to 47.4% while the percentage of service revenue from TCM declined from 26.4% to 18.8% from 1999 to 2004. Percentages of revenue from laboratory tests and surgical procedures for both types of hospitals increased and the discrepancy between the two types of hospitals was narrowed from 1999 to 2004. For TCM hospitals, revenues from laboratory tests increased from 3.64% to 5.06% and revenues from surgical procedures increased from 3.44% to 7.02%. General hospitals' TCM drug revenue in outpatient care declined insignificantly from 5.26% to 3.87%, while the decline for the TCM hospitals was significant from 19.73% to 13.77%. The national statistics from 1999 to 2008 showed similar trends that the percentage of revenue from Western medicine for TCM hospitals increased from 59.6% in 1999 to 62.2% in 2003 and 66.1% in 2008 while the percentage of revenue from TCM for TCM hospitals decreased from 18.0% in 1999, 15.4% in 2003, and 13.7% in 2008. Western medicine has become a vital revenue source for TCM hospitals in the current Chinese health care environment where government subsidies to health care facilities have significantly declined. Policies need to encourage TCM hospitals to identify their own special and effective services, improve public perception, increase demand, strengthen financial sources, and ultimately make contributions to preserving one of the national treasures.

  20. Medical Home Features of VHA Primary Care Clinics and Avoidable Hospitalizations.

    PubMed

    Yoon, Jean; Rose, Danielle E; Canelo, Ismelda; Upadhyay, Anjali S; Schectman, Gordon; Stark, Richard; Rubenstein, Lisa V; Yano, Elizabeth M

    2013-09-01

    As the Veterans Health Administration (VHA) reorganizes providers into the patient-centered medical home, questions remain whether this model of care can demonstrate improved patient outcomes and cost savings. We measured adoption of medical home features by VHA primary care clinics prior to widespread implementation of the patient-centered medical home and examined if they were associated with lower risk and costs of potentially avoidable hospitalizations. Secondary patient data was linked to clinic administrative and survey data. Patient and clinic factors in the baseline year (FY2009) were used to predict patient outcomes in the follow-up year. 2,853,030 patients from 814 VHA primary care clinics Patient outcomes were measured by hospitalizations for an ambulatory care sensitive condition (ACSC) and their costs and identified through diagnosis and procedure codes from inpatient records. Clinic adoption of medical home features was obtained from the American College of Physicians Medical Home Builder®. The overall mean home builder score in the study clinics was 88 (SD = 13) or 69%. In adjusted analyses an increase of 10 points in the medical home adoption score in a clinic decreased the odds of an ACSC hospitalization for patients by 3% (P = 0.032). By component, higher access and scheduling (P = 0.004) and care coordination and transitions (P = 0.020) component scores were related to lower risk of an ACSC hospitalization, and higher population management was related to higher risk (P = 0.023). Total medical home features was not related to ACSC hospitalization costs among patients with at least one (P = 0.074). Greater adoption of medical home features by VHA primary care clinics was found to be significantly associated with lower risk of avoidable hospitalizations with access and scheduling and care coordination/transitions in care as key factors.

  1. A proposed framework to improve the safety of medical devices in a Canadian hospital context

    PubMed Central

    Polisena, Julie; Jutai, Jeffrey; Chreyh, Rana

    2014-01-01

    Purpose Medical devices are used to monitor, replace, or modify anatomy or physiological processes. They are important health care innovations that enable effective treatment using less invasive techniques, and they improve health care delivery and patient outcomes. Devices can also introduce risk of harm to patients. Our objective was to propose a surveillance system framework to improve the safety associated with the use of medical devices in a hospital. Materials and methods The proposed medical device surveillance system incorporates multiple components to accurately document and assess the appropriate actions to reduce the risk of incidents, adverse events, and patient harm. The assumptions on which the framework is based are highlighted. The surveillance system was designed from the perspective of a tertiary teaching hospital that includes dedicated hospital staff whose mandate is to provide safe patient care to inpatients and outpatients and biomedical engineering services. Results The main components of the surveillance system would include an adverse