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Gyedu A, Amponsah-Manu F, Awuku K, Ameyaw E, Korankye KK, Donkor P, Mock C. Differences in trauma care between district and regional hospitals and impact of a trauma intake form with decision support prompts in Ghana: A stepped-wedge cluster randomized trial. World J Surg 2024; 48:527-539. [PMID: 38312029 PMCID: PMC10960944 DOI: 10.1002/wjs.12082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 01/20/2024] [Indexed: 02/06/2024]
Abstract
BACKGROUND We sought to determine the achievement of key performance indicators (KPIs) of initial trauma care at district (first-level) and regional (second-level) hospitals in Ghana and to assess the effectiveness of a standardized trauma intake form (TIF) to improve care. METHODS A stepped-wedge cluster randomized trial was performed with direct observations of trauma management before and after introducing the TIF at emergency units of eight hospitals for 17.5 months. Differences in KPIs were assessed using multivariable logistic regression and generalized linear mixed regression. RESULTS Management of 4077 patients was observed; 30% at regional and 70% at district hospitals. Eight of 20 KPIs were performed significantly more often at regional hospitals. TIF improved care at both levels. Fourteen KPIs improved significantly at district and eight KPIs improved significantly at regional hospitals. After TIF, regional hospitals still performed better with 18 KPIs being performed significantly more often than district hospitals. After TIF, all KPIs were performed in >90% of patients at regional hospitals. Examples of KPIs for which regional performed better than district hospitals after TIF included: assessment for oxygen saturation (83% vs. 98%) and evaluation for intra-abdominal bleeding (82% vs. 99%, all p < 0.001). Mortality decreased among seriously injured patients (injury severity score ≥9) at both district (15% before vs. 8% after, p = 0.04) and regional (23% vs. 7%, p = 0.004) hospitals. CONCLUSIONS TIF improved care and lowered mortality at both hospital levels, but KPIs remained lower at district hospitals. Further measures are needed to improve initial trauma care at this level. CLINICAL TRIALS REGISTRATION Clinicaltrials.gov (NCT04547192).
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Affiliation(s)
- Adam Gyedu
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | | | | | | | - Peter Donkor
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Charles Mock
- Department of Surgery, University of Washington, Seattle, Washington, USA
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Liu YH, Sia J, Munas A, Tacon C, Salaveria K, Lutshaba HL, Hanson J. Utility of rotational thromboelastometry in the management of massive haemorrhage at a regional Australian hospital. Transfus Med 2024; 34:54-60. [PMID: 38030560 DOI: 10.1111/tme.13018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 09/14/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Rotational thromboelastometry (ROTEM) allows targeted and individualised blood product replacement. OBJECTIVES The study aimed to determine the impact of ROTEM-guided transfusion on the clinical course of patients with acute massive haemorrhage in a regional Australian hospital. METHODS/MATERIALS A retrospective review of all patients with acute massive haemorrhage that compared the characteristics, blood product use, and clinical outcomes of patients with massive haemorrhage before and after the introduction of ROTEM-guided transfusion. RESULTS In per-protocol analysis, the 31/97 (32%) with ROTEM-guided transfusion used less packed red blood cells (median [interquartile range]: 6 [6-8] vs. 8 [6-12] units, p = 0.03) than patients whose transfusion was not ROTEM-guided. They were also less likely to receive fresh frozen plasma (2/31 [6%] vs. 45/66 [68%], p < 0.0001) or platelets (2/31 [6%] vs. 31/66 [47%], p < 0.0001); they were, however, more likely to receive fibrinogen products (26/31 [84%] vs. 38/66 [58%], p = 0.01). Patients receiving ROTEM-guided transfusion had lower in-hospital mortality (6/31 [19%] vs. 20/66 [30%], odds ratio 0.55 [95% confidence interval]: 0.20-1.55, p = 0.26) although this did not achieve statistical significance in this small cohort. CONCLUSION ROTEM-guided massive transfusion of patients with acute haemorrhage in this regional Australian hospital led to a reduction in packed red blood cell, fresh frozen plasma, and platelet utilisation and may also have reduced mortality.
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Affiliation(s)
- Yu-Hsuan Liu
- Department of Intensive Care, Cairns Hospital, Cairns, Queensland, Australia
- Department of Anaesthesia, Cairns Hospital, Cairns, Queensland, Australia
| | - Jessica Sia
- Department of Haematology, Cairns Hospital, Cairns, Queensland, Australia
| | - Azhar Munas
- Department of Haematology, Cairns Hospital, Cairns, Queensland, Australia
| | - Catherine Tacon
- Department of Intensive Care, Cairns Hospital, Cairns, Queensland, Australia
| | - Kris Salaveria
- Department of Intensive Care, Cairns Hospital, Cairns, Queensland, Australia
| | | | - Josh Hanson
- Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia
- The Kirby Institute, Sydney, New South Wales, Australia
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Fujimori T, Ohta R, Sano C. Diagnostic Errors in Japanese Community Hospitals and Related Factors: A Retrospective Cohort Study. Healthcare (Basel) 2023; 11:healthcare11111539. [PMID: 37297679 DOI: 10.3390/healthcare11111539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/19/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023] Open
Abstract
Diagnostic error has recently become a crucial clinical problem and an area of intense research. However, the reality of diagnostic errors in regional hospitals remains unknown. This study aimed to clarify the reality of diagnostic errors in regional hospitals in Japan. A 10-month retrospective cohort study was conducted from January to October 2021 at the emergency room of Oda Municipal Hospital in central Shimane Prefecture, Japan. Participants were divided into groups with or without diagnostic errors, and independent variables of patient, physician, and environmental factors were analyzed using Fisher's exact test, univariate (Student's t-test and Welch's t-test), and logistic regression analyses. Diagnostic errors accounted for 13.1% of all eligible cases. Remarkably, the proportion of patients treated without oxygen support and the proportion of male patients were significantly higher in the group with diagnostic errors. Sex bias was present. Additionally, cognitive bias, a major factor in diagnostic errors, may have occurred in patients who did not require oxygen support. Numerous factors contribute to diagnostic errors; however, it is important to understand the trends in the setting of each healthcare facility and plan and implement individualized countermeasures.
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Affiliation(s)
- Taichi Fujimori
- Faculty of Medicine, Shimane University, 89-1 Enya-cho, Izumo 693-8501, Japan
- Oda Municipal Hospital, 1428-3 Yoshinaga, Oda-cho, Oda 694-0063, Japan
| | - Ryuichi Ohta
- Community Care, Unnan City Hospital, 699-1221 96-1 Iida, Daito-cho, Unnan 699-1221, Japan
| | - Chiaki Sano
- Department of Community Medicine Management, Faculty of Medicine, Shimane University, 89-1 Enya cho, Izumo 693-8501, Japan
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Walsh K, Gezer N, Gaborit L, Zhou W, Banerjee A. Bones, groans and sending patients home: Perioperative opioid-related harm reduction strategy utilisation in a regional New South Wales (NSW) hospital. Aust J Rural Health 2023. [PMID: 36745537 DOI: 10.1111/ajr.12965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 12/21/2022] [Accepted: 01/01/2023] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Perioperative initiation of opioids continues to be a major contributor to chronic use, misuse and diversion in regional areas. There is considerable effort to mitigate harm through avoiding excessive prescribing and reducing the risk of persistent postoperative opioid use. Improving perioperative documentation practices has been reported to ensure appropriate opioid initiation and de-escalation. It has not been established whether these strategies are utilised in regional hospitals. METHODS A retrospective observational study of perioperative opioid prescribing and documentation practices in Goulburn Base Hospital, a regional centre in the Southern New South Wales (NSW) Local Health District. Data were collected from 110 records and validated for adult patients undergoing elective total knee replacement (TKR) or total hip replacement (THR) from 12 January 2020 to 13 January 2021. OUTCOME MEASURES To observe perioperative opioid prescribing and utilisation of harm reduction strategies in a regional hospital. RESULTS 65% of patients were opioid naïve (ON). Preoperative pain assessments and patient education were completed in 23% and 15% of records, respectively. Postoperative opioids were prescribed for 99% of patients, with 74% prescribed a slow-release (SR) formulation. 50% of patients were discharged with an SR prescription. Inadequate postoperative pain control was reported in 21% of patients. Of the 103 patients prescribed opioids on discharge, only 20% included a de-escalation plan and only 35% of discharge summaries included dose and quantity of opioids supplies. CONCLUSIONS This study has identified underutilisation of perioperative harm reduction strategies despite the potential to improve appropriate initiation and de-escalation of opioids. These findings highlight opportunities for improvement in regional hospitals.
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Affiliation(s)
- Kelsey Walsh
- ANU Medical School, Garran, Australian Capital Territory, Australia
| | - Nesha Gezer
- ANU Medical School, Garran, Australian Capital Territory, Australia
| | - Lorane Gaborit
- ANU Medical School, Garran, Australian Capital Territory, Australia
| | - William Zhou
- ANU Medical School, Garran, Australian Capital Territory, Australia
| | - Arnab Banerjee
- Goulburn Base Hospital, ANU Medical School, Goulburn, New South Wales, Australia
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Chung CH. Trends in pharmaceutical expenditure in the Taiwan National Health Insurance database at different hospital levels. J Comp Eff Res 2023; 12:e220162. [PMID: 36511826 PMCID: PMC10286779 DOI: 10.2217/cer-2022-0162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/29/2022] [Indexed: 12/15/2022] Open
Abstract
Aim: This study aimed to understand the medication usage among different hospitals in Taiwan. Materials & methods: The NHI claims database consisting of claims prescription drugs in Taiwan was used to determine drug prescriptions in different hospitals. Results: In the medical center, L01X showed the highest drug expenditure and the drug prescription pattern in regional hospitals was similar to that in the medical center. The highest drug expenditure in the district hospital and clinics was A10B. Conclusion: Our analysis suggests that the annual pharmaceutical expenditures from 2016 to 2018 were increasing over time in all hospitals. The generic drug usage in medical centers/regional hospitals was lower than district hospitals/clinics.
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Affiliation(s)
- Ching-Hu Chung
- Department of Medicine, Mackay Medical College, New Taipei City 252, Taiwan
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6
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Fadaee N, Gaszynski R, Merrett N, Gray A. Laparoscopic fundoplication performed in community hospital settings: A protocol for systematic review. Medicine (Baltimore) 2023; 102:e32502. [PMID: 36607888 PMCID: PMC9829280 DOI: 10.1097/md.0000000000032502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Laparoscopic fundoplication (LF) is well-established as the surgical intervention of choice for management of refactory gastro-esophageal reflux disease. Much of its success lies in the reported benefits in symptom control outlined by the postoperative patient. It is unclear whether patient-reported outcomes differ according to the institution type providing care. This review aimed to address this knowledge gap by reviewing the available evidence examining patient-reported outcomes of LF in non-metropolitan centers. OBJECTIVES To investigate patient-reported outcomes of LF performed in regional or community-based hospitals. DATA SOURCES Four electronic databases, and citations of relevant articles. STUDY ELIGIBILITY CRITERIA Only studies that separately reported patient-reported outcomes of LF performed in regional or community hospitals were included; papers deemed to be unclear about the type of facility in which LF surgeries were performed, or in which data from LF surgeries performed in regional/community hospitals was combined with data from major metropolitan hospitals, were excluded. STUDY APPRAISAL Only studies that were graded as fair or good using Quality Assessment Tool for Observational Cohort and Cross-sectional studies were eligible for inclusion in this review. Seven studies were then eligible for inclusion, all of which were observational cohort studies with 6 of the studies reporting on a single intervention arm. RESULTS Seven observational cohort studies were included in the review, with a combined total of 1071 patients who underwent LF at non-metropolitan centers. Of these, data was collected for 742 patients, yielding an overall response rate of 69.3%. All 7 studies assessed patients' post-operative outcomes through questionnaires that were based on a modified Likert scale or a similar tool. Overall patient satisfaction was high (86%) and a significant majority of patients stated they would recommend the procedure to others (93.3%). Post-operative prevalence of reflux and dysphagia compared favorably to rates generally reported in the literature (11.9% and 17.6% respectively). Further research is required to ascertain the safety of performing these procedures in non-metropolitan hospitals. CONCLUSION Current evidence suggests that patient-reported outcomes are favorable for patients undergoing LF in community settings, and are broadly comparable to those undergoing LF in tertiary-level centers.
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Affiliation(s)
- Neesa Fadaee
- Department of Upper Gastrointestinal Surgery, Liverpool Hospital, Liverpool, NSW, Australia
| | - Rafael Gaszynski
- Department of Upper Gastrointestinal Surgery, Liverpool Hospital, Liverpool, NSW, Australia
| | - Neil Merrett
- Department of Upper Gastrointestinal Surgery, Liverpool Hospital, Liverpool, NSW, Australia
| | - Andrew Gray
- Department of Upper GI & HPB Surgery, Monash Medical Centre, Clayton, VIC, Australia
- * Correspondence: Andrew Gray, Department of Upper GI & HPB Surgery, Monash Medical Centre, Clayton, VIC, Australia (e-mail: )
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Fatima M, Scholes CJ, Tutty A, Ebrahimi M, Genon M, Martin SJ. Patient-reported outcomes of a short hospital stay after total knee replacement in a regional public hospital: a prospective cohort treated 2018-2019. ANZ J Surg 2022; 92:837-842. [PMID: 35187772 DOI: 10.1111/ans.17531] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/16/2021] [Accepted: 01/17/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patient-reported outcomes and satisfaction following short length of stay (LoS) after total knee arthroplasty (TKA) in the Australian regional context remain unexplored. This study reports complications, outcomes and satisfaction of patients discharged from an enhanced recovery protocol (ERP), 6 weeks after TKA in a regional hospital. METHODS Prospective recruitment occurred between 2018 and 2019. Demographics, intraoperative data, complications and emergency department (ED) presentations were retrieved from hospital records. Complications were graded for severity using a published scale. Knee range of motion (ROM), timed up-and-go (TUG), 6-min walk test (6MWT) and Oxford Knee Scores (OKS) were assessed preoperatively and 6 weeks postoperatively. Patient satisfaction was assessed via questionnaire at the postoperative follow-up. RESULTS One hundred patients/117 primary TKAs were prospectively included. Median LoS was 2 days (interquartile range 1-3 days) with 74.4% and 88.4% of patients satisfied with their knee and LoS, at 6 weeks respectively. Twenty-seven patients presented to the ED a total of 37 times with complication severity of Grade III or less, and 10 patients were readmitted. Significant improvements in objective and subjective outcomes were observed, however only change in median OKS exceeded the minimal clinically important difference (MCID) threshold. CONCLUSION An enhanced recovery protocol after TKA in a regional hospital can achieve a median LoS of 2 days without compromising patient-reported outcomes and objective functional measures, whilst maintaining a high level of patient satisfaction with both the surgery and LoS. Further work is required to better optimize management of largely low-grade complications in this patient population.
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Affiliation(s)
| | | | - Amanda Tutty
- Grafton Base Hospital, Northern NSW Local Health District, Sydney, New South Wales, Australia.,The Specialist Orthopaedic Centre, Sydney, New South Wales, Australia
| | | | - Michel Genon
- Grafton Base Hospital, Northern NSW Local Health District, Sydney, New South Wales, Australia.,The Specialist Orthopaedic Centre, Sydney, New South Wales, Australia
| | - Samuel J Martin
- Grafton Base Hospital, Northern NSW Local Health District, Sydney, New South Wales, Australia.,The Specialist Orthopaedic Centre, Sydney, New South Wales, Australia
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Teo J, Silva MT, Van Rooyen H. Emphysematous Pyelonephritis Complicated by Necrotising Fasciitis and Massive Pulmonary Embolus: A Regional Australian Experience. Cureus 2021; 13:e18347. [PMID: 34725601 PMCID: PMC8555752 DOI: 10.7759/cureus.18347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2021] [Indexed: 11/05/2022] Open
Abstract
A 39-year-old female presented to a regional Australian hospital with diabetic ketoacidosis. Urine microscopy, culture and sensitivity (MCS) on arrival revealed 500 leukocytes and eventually culture grew pansensitive E. coli. Patient was transferred to ICU for ongoing care where she remained tachycardic despite resolution of her diabetic ketoacidosis. A CT pulmonary angiogram was performed which found a right lower lobe pulmonary embolus for which therapeutic anticoagulation was commenced. However, tachycardia persisted and the patient became febrile on day three of admission. A CT abdomen pelvis was performed which revealed left-sided emphysematous pyelonephritis secondary to a large staghorn calculus. Significant subcutaneous emphysema was also found in the left flank. A general surgery review was requested and the case was discussed with the urology team located at a tertiary centre. The patient was subsequently transferred to a tertiary hospital under urology where she underwent a left nephrectomy and wound debridement. This was complicated by colonic perforation and was repaired with an omental patch with a loop ileostomy formed. Patient underwent a total of six relooks and debridements before the wound was closed with a combination of delayed primary closure and split-thickness skin graft.
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Affiliation(s)
- Joshua Teo
- Surgery, Queensland Health, Brisbane, AUS
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Karachentsev S. Blunt trauma to abdominal solid organs: an experience of non-operative management at a rural hospital in Zambia. Pan Afr Med J 2021; 38:89. [PMID: 33889255 PMCID: PMC8033190 DOI: 10.11604/pamj.2021.38.89.20061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 11/13/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction although non-operative management of patients with blunt trauma to abdominal solid organs has become standard care, the role of peripheral hospitals remains poorly defined. This study reviews treatment and outcomes in patients with liver and spleen injuries at a regional hospital over a 10-year period. Methods a retrospective review of prospectively collected data was performed and supplemented by case notes retrieval. All patients with solid visceral injuries managed between 2009 and 2019 at a rural surgical hospital in Zambia were included. On admission, the patients were offered either urgent laparotomy or non-operative management (NOM) depending on their haemodynamic status. Continuous variables were expressed as median and mean ± standard deviation; categorical data were expressed as percentages. Statistical evaluation of data was performed by two-sample t-test. Statistical significance was assigned at p<0.05. Results fourty-three patients were included. The majority of victims sustained isolated spleen or liver injury. Twenty-three patients were urgently operated due to haemodynamic instability. Splenectomy performed in 17 patients, liver laceration sutured in 5 patients. One patient underwent concomitant splenectomy and liver repair. Conservative management was attempted in 20 (47%) patients and was successful in 18 (42%). In two patients NOM failed and splenectomy was performed urgently. Two patients died postoperatively. There were no deaths in NOM group. Conclusion NOM of patients with injury to solid abdominal organs could be safely initiated in rural hospitals provided there is uninterrupted monitoring of patients' condition, well-trained staff and unrestricted access to the operating theatre (OT).
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Yan YH, Kung CM, Hsing SC. Emotional Labor Is Associated With the Mental Health of Respiratory Therapists in Hospitals. Respir Care 2021; 66:50-57. [PMID: 32900915 PMCID: PMC9993835 DOI: 10.4187/respcare.07675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Respiratory therapists (RTs) play important roles in providing ventilator support to patients in hospitals. They are on the front line in respiratory cases and work with physicians to help patients survive. However, questions remain regarding whether the mental health conditions at work are protected and secured for RTs. This study aimed to explore the risk factors of mental illness for RTs and to design an app to allow individual RTs to seek assistance at an earlier stage. METHODS A total of 642 RTs from 107 two-tiered hospitals in Taiwan were randomly selected to complete a 44-item, 5-category questionnaire regarding emotional labor and mental health in 2019. Exploratory factor analysis, the Rasch model, descriptive statistics, the nonparametric Mann-Whitney U test, the Kruskal-Wallis test for unpaired t test, and one-way analysis of variance were performed to examine the demographic characteristics and emotional labor and mental health factors that influence RTs' mental health. An app was then designed to evaluate their mental health status. RESULTS A total of 352 questionnaires were eligible, with a return rate of 54.8% (352 of 642). About 62.8% came from medical centers and 37.2% from regional hospitals. There were 311 (88.4%) women and 41 (11.6%) men, with a mean ± SD age of 37 ± 9.5 y. Six construct factors were extracted from the responses. The overall reliability of the emotional labor and mental health questionnaire for each subscale beyond 0.70 was evident based on internal consistency and stability in the data. Four risk factors (ie, basic emotional expression, superficial emotional control, emotional diversity extent, and weekly work hours) influenced RT mental health. All findings were applied to design an app for RTs to evaluate their mental health at work. CONCLUSIONS Four risk factors were verified to influence RT mental health. An app was developed to detect their mental health and allow them to seek assistance at an earlier stage.
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Affiliation(s)
- Yu-Hua Yan
- Department of Medical Research, Tainan Municipal Hospital, Tainan City, Taiwan.
- Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan City, Taiwan
| | - Chih-Ming Kung
- Department of Information Technology and Communication, Shih Chien University Kaohsiung, Kaohsiung, Taiwan
| | - Shu-Chen Hsing
- Department of Respiratory Therapy, Chi-Mei Medical Center, Yung-kang City, Taiwan
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Rana R, Gow J, Moloney C, King A, Keijzers G, Beccaria G, Mullens A. Does distance to hospital affect emergency department presentations and hospital length of stay among COPD patients? Intern Med J 2020; 52:403-410. [PMID: 32786063 DOI: 10.1111/imj.15014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/20/2020] [Accepted: 08/09/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The primary goal of COPD management is to optimize a patient's functional status and quality of life. By encouraging effective patient self-management within primary health care, unplanned and potentially avoidable COPD admissions to the emergency department can be avoided. AIM The aim of this study is to examine whether distance to hospital influences the rate of ED presentation, hospital admission and hospital length of stay for COPD patients. METHODS The 2016 to 2018 resulted in a total of 5253 patient presentations with a primary medical diagnosis code of J44 (COPD). These were at the main hospitals of three Queensland Hospital and Health Services: Toowoomba, Ipswich and Gold Coast. To examine the variations in patient characteristics based on distance a one-way ANOVA (Analysis of Variance) test was conducted. The Kruskal-Wallis (KW) test indicated that there were group differences. RESULTS This study identified significant variation in COPD-related hospital length of stay and distance to hospital among COPD patients within three hospitals in South East Queensland, Australia. These results confirm that distance plays an important role in determining duration of hospital stay (in number of days) among COPD patients, with clear evidence of the distance 'decay phenomenon'. It appears from the findings of the current study that distance to the hospital is not associated with the greater likelihood of ED presentation but may influence length of stay. CONCLUSIONS Several distance-specific studies have concluded that lower utilisation of hospital care is associated with distance to hospital. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Rezwanul Rana
- School of Commerce, University of Southern Queensland, Toowoomba, Australia
| | - Jeff Gow
- School of Commerce, University of Southern Queensland, Toowoomba, Australia.,School of Accounting, Economics and Finance, University of KwaZulu-Natal, Durban, South Africa
| | - Clint Moloney
- School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, Australia
| | - Alex King
- Emergency Department, Toowoomba Hospital, Darling Downs Hospital and Health Service, Toowoomba, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Gerben Keijzers
- Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast Hospital and Health Service, Southport, Australia.,Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia.,School of Medicine, Griffith University, Gold Coast, Australia
| | - Gavin Beccaria
- School of Psychology, University of Southern Queensland, Toowoomba, Australia
| | - Amy Mullens
- School of Psychology, University of Southern Queensland, Toowoomba, Australia
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Fujiwara J, Matsumoto S, Yamanaka K, Sekine M, Ishii T, Ajimine T, Mashima H. Introduction of gastric endoscopic submucosal dissection and skill acquisition in a regional hospital. JGH Open 2020; 4:230-235. [PMID: 32280769 PMCID: PMC7144776 DOI: 10.1002/jgh3.12249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/01/2019] [Accepted: 08/04/2019] [Indexed: 11/13/2022]
Abstract
Background and Aim Endoscopic submucosal dissection (ESD) is standard treatment for early gastric cancer. With aging of the population in Japan being more pronounced in rural areas, the availability of ESD at regional hospitals is becoming important. Here, we assessed the learning curve of one physician for skill acquisition in gastric ESD. Methods The subjects were 34 patients (38 lesions) who underwent gastric ESD at a regional hospital between October 2014 and March 2017 and 15 patients (15 lesions) who underwent the procedure at a university hospital between April 2017 and April 2018. The resection periods of the first 19 lesions and subsequent 19 lesions at the regional hospital were defined as the first and seconds periods, and the resection period of 15 lesions at the university hospital was defined as the third period. The learning curve across the three periods was assessed using the cumulative sum analysis method. Results The resection speed in the first, second, and third periods were 6.4 ± 4.1, 6.9 ± 3.4, and 9.4 ± 5.4 mm2/min, respectively (not significant). The slope of the learning curve began to increase at the 30th patient. The en bloc resection and curative resection rates did not differ significantly among the three periods. There were no serious procedure‐related complications. Conclusion This study showed that the introduction of gastric ESD at a regional hospital is possible, and that a certain skill level was acquired by the 30th patient. Furthermore, with careful patient selection, favorable results can be obtained and procedural safety ensured.
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Affiliation(s)
- Junichi Fujiwara
- Department of Gastroenterology, Saitama Medical Center Jichi Medical University Saitama Japan
| | - Satohiro Matsumoto
- Department of Gastroenterology, Saitama Medical Center Jichi Medical University Saitama Japan
| | - Kenichi Yamanaka
- Department of Gastroenterology, Saitama Medical Center Jichi Medical University Saitama Japan
| | - Masanari Sekine
- Department of Gastroenterology, Saitama Medical Center Jichi Medical University Saitama Japan
| | - Takehiro Ishii
- Department of Gastroenterology, Saitama Medical Center Jichi Medical University Saitama Japan
| | - Takuma Ajimine
- Department of Gastroenterology Kitaakita City Hospital Akita Japan
| | - Hirosato Mashima
- Department of Gastroenterology, Saitama Medical Center Jichi Medical University Saitama Japan
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Bagot KL, Bladin CF, Vu M, Kim J, Hand PJ, Campbell B, Walker A, Donnan GA, Dewey HM, Cadilhac DA. Exploring the benefits of a stroke telemedicine programme: An organisational and societal perspective. J Telemed Telecare 2017; 22:489-494. [PMID: 27799453 DOI: 10.1177/1357633x16673695] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 09/15/2016] [Indexed: 12/25/2022]
Abstract
We undertook a qualitative analysis to identify the broader benefits of a state-wide acute stroke telemedicine service beyond the patient-clinician consultation. Since 2010, the Victorian Stroke Telemedicine (VST) programme has provided a clinical service for regional hospitals in Victoria, Australia. The benefits of the Victorian Stroke Telemedicine programme were identified through document analysis of governance activities, including communications logs and reports from hospital co-ordinators of the programme. Discussions with the Victorian Stroke Telemedicine management were undertaken and field notes were also reviewed. Several benefits of telemedicine were identified within and across participating hospitals, as well as for the state government and community. For hospitals, standardisation of clinical processes was reported, including improved stroke care co-ordination. Capacity building occurred through professional development and educational workshops. Enhanced networking, and resource sharing across hospitals was achieved between hospitals and organisations. Governments leveraged the Victorian Stroke Telemedicine programme infrastructure to provide immediate access to new treatments for acute stroke care in regional areas. Standardised data collection allowed routine quality of care monitoring. Community awareness of stroke symptoms occurred with media reports on the novel technology and improved patient outcomes. The value of telemedicine services extends beyond those involved in the clinical consultation to healthcare funders and the community.
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Affiliation(s)
- Kathleen L Bagot
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia .,Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Christopher F Bladin
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia.,Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Box Hill, Australia
| | - Michelle Vu
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
| | - Joosup Kim
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia.,Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
| | - Peter J Hand
- Department of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Bruce Campbell
- Eastern Health Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Box Hill, Australia.,Department of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
| | - Alison Walker
- Medical Services, Mildura Base Hospital, Mildura, Australia
| | - Geoffrey A Donnan
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia
| | - Helen M Dewey
- Medical Services, Mildura Base Hospital, Mildura, Australia
| | - Dominique A Cadilhac
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia.,Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia
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Reddy S, Carey TA, Wakerman J. A Realist Case Study of a Regional Hospital's Response to Improve Emergency Department Access in the Context of Australian Health Care Reforms. Health Serv Res Manag Epidemiol 2016; 3:2333392816631101. [PMID: 28462274 PMCID: PMC5266455 DOI: 10.1177/2333392816631101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 01/06/2016] [Accepted: 01/07/2016] [Indexed: 11/23/2022] Open
Abstract
Introduction: Major health-care reforms have extended across all Australian public hospitals in recent years. Improving emergency department (ED) access has been a focus of these reforms. Objective: This study evaluates how the national reforms have led to improvement in ED access in a regional hospital in remote Australia. Methods: Assessing a complex scenario such as national reforms and the challenges faced by the regional hospital to implement these reforms requires in-depth analysis. A realist evaluation theory-based approach was employed, allowing investigation of what, how, why, and for whom change occurred. A case study mixed methods design was adopted within the realist framework to answer these questions about change. Results and Conclusion: The study identified moderate improvement in ED access as a result of the reforms (investment in infrastructure and workforce and the introduction of ED targets). Clinical leadership and support from management were essential for the improvement. Without ongoing investment and clinical redesign activities, however, sustainability of the improvement may prove difficult.
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Affiliation(s)
- Sandeep Reddy
- Centre for Remote Health, a Joint Centre of Flinders University and Charles Darwin University, Alice Springs, Northern Territory, Australia
| | - Timothy A Carey
- Centre for Remote Health, a Joint Centre of Flinders University and Charles Darwin University, Alice Springs, Northern Territory, Australia
| | - John Wakerman
- Flinders NT, Flinders University, Darwin, Northern Territory, Australia
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Cheek C, Allen P, Shires L, Parry D, Ruigrok M. Low-acuity presentations to regional emergency departments: What is the issue? Emerg Med Australas 2015; 28:145-52. [PMID: 26708775 DOI: 10.1111/1742-6723.12526] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 10/12/2015] [Accepted: 11/04/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To explore GP-referrals and self-referrals to EDs and factors associated with patients seeking low-acuity care at ED. METHOD Retrospective analysis of all ED presentations to Mersey Community Hospital and North West Regional Hospital (Tasmania) between 1 January 2009 and 31 December 2013. Cross-sectional survey of patients presenting to the EDs for care triaged as low-acuity. RESULTS There were 255,365 ED presentations in the retrospective data: 11,252 (4.4%) GP-referrals and 218,205 (85.4%) self-referrals. At ED 49% of GP-referrals were triaged ATS 4 or 5 and 35% of self-referrals were triaged ATS 1-3. There were 138 (84.2%) low-acuity patients who completed the survey; predominantly, all attended for acute injury or illness. Single point-of-care convenience was most commonly selected (71%) as a reason for attending ED. CONCLUSIONS Over 85% of patients who seek emergency care in this region self-refer, so understanding health-seeking behaviour is important. Most low-acuity patients are acutely injured or unwell, and the decision to go to ED is based on their perception of accessibility of expertise aligned with their need. The term 'GP-type' is misleading in this context and should not be used. Providing low-acuity care in parallel with providing a specialised emergency service meets the needs of the local community and is likely to be the lowest cost model in a regional and rural area. Funding models must reflect the actual cost of delivering this important service rather than presentation types.
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Affiliation(s)
- Colleen Cheek
- Rural Clinical School, University of Tasmania, Burnie, Tasmania, Australia
| | - Penny Allen
- Rural Clinical School, University of Tasmania, Burnie, Tasmania, Australia
| | - Lizzi Shires
- Rural Clinical School, University of Tasmania, Burnie, Tasmania, Australia
| | - Denise Parry
- Tasmanian Health Organisation North West, North West Regional Hospital, Burnie, and Mersey Community Hospital, Latrobe, Tasmania, Australia
| | - Marielle Ruigrok
- Tasmanian Health Organisation North West, North West Regional Hospital, Burnie, and Mersey Community Hospital, Latrobe, Tasmania, Australia
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