Organisational and financial consequences of the early discharge of patients treated for acute bacterial skin and skin structure infection and osteomyelitis in infectious disease departments in Greece, Italy and Spain: a scenario analysis

OBJECTIVE

The aim of the analysis is to assess the organisational and economic consequences of adopting an early discharge strategy for the treatment of acute bacterial skin and skin structure infection (ABSSSI) and osteomyelitis within infectious disease departments.

SETTING

Infectious disease departments in Greece, Italy and Spain.

PARTICIPANTS

No patients were involved in the analysis performed.

INTERVENTIONS

An analytic framework was developed to consider two alternative scenarios: standard hospitalisation care or an early discharge strategy for patients hospitalised due to ABSSSI and osteomyelitis, from the perspective of the National Health Services of Greece, Italy and Spain. The variables considered were: the number of annual hospitalisations eligible for early discharge, the antibiotic treatments considered (ie, oral antibiotics and intravenous long-acting antibiotics), diagnosis-related group (DRG) reimbursements, number of days of hospitalisation, incidence and costs of hospital-acquired infections, additional follow-up visits and intravenous administrations. Data were based on published literature and expert opinions.

PRIMARY AND SECONDARY OUTCOME MEASURES

Number of days of hospitalisation avoided and direct medical costs avoided.

RESULTS

The total number of days of hospitalisation avoided on a yearly basis would be between 2216 and 5595 in Greece (-8/-21 hospital beds), between 15 848 and 38 444 in Italy (-57/-135 hospital beds) and between 7529 and 23 520 in Spain (-27/-85 hospital beds). From an economic perspective, the impact of the early discharge scenario is a reduction between €45 036 and €149 552 in Greece, a reduction between €182 132 and €437 990 in Italy and a reduction between €292 284 and €884 035 in Spain.

CONCLUSIONS

The early discharge strategy presented would have a positive organisational impact on National Health Services, leading to potential savings in beds, and to a reduction of hospital-acquired infections and costs.

Addition of explicit guidance to acute pancreatitis guidelines increases compliance with amylase measurement recommendations

AIM

Hospital HealthPathways is an online database of local clinical guidelines produced by a dedicated team for use within Canterbury District Health Board (CDHB) hospitals. A 'Practice Point'-a bullet point making explicit a recommendation within the body of a clinical guideline-was added to the guideline for acute pancreatitis, instructing users to avoid serial measurements of serum amylase levels. The aim was to explore whether the addition of this Practice Point affected compliance with the amylase measurement recommendations.

METHOD

The number of serum amylase tests requested for patients admitted with acute pancreatitis by GPs and doctors working in the emergency department, general surgery and other departments was audited using the CDHB's online clinical information system. A data set from a six-month period ending three months prior to the addition of the Practice Point, collected for a previous study, was used with the author's permission as a control group. A new data set from a six-month period starting three months after the addition of the Practice Point formed the experimental group.

RESULTS

Compliance rose by 13% after the addition of the Practice Point. Before the Practice Point was added to the guideline, 82 of 126 total patients (65%) had amylase measured only once, on admission, in compliance with the Hospital HealthPathway guideline. After the addition of the Practice Point, 142 of 182 patients (78%) had one measurement of amylase. This improvement was seen where patients were referred directly by their GP to the general surgical teams and patients managed by other specialties. Variation in compliance seen over the six-month experimental group period was significant, but did not show a clear trend of either improvement or decay in compliance.

CONCLUSION

This supports the hypothesis that the simple intervention of clarifying a key point within a clinical guideline can have a significant positive effect on compliance. This is an important consideration for guideline authors and institutions publishing clinical guidelines, as poor compliance by clinicians is reported in studies. The intervention in this study is a simple change for guidelines based online, and the significant effect could contribute to improvement in patient-centred, financial and clinical domains.

Lymphomas diagnosed in an internal medicine department compared to lymphomas diagnosed in other departments: Clinical and outcome differences

Lymphomas are common malignancies with highly variable clinical presentations and prognosis. Prognostic value of clinical presentation at onset is still questioned. The objective of this study was to compare the disease presentation and the outcome of lymphomas diagnosed in an Internal Medicine Department of a University Hospital to disease presentation and outcome of patients who were referred to the Hematology Department of the same institution by other departments or healthcare facilities.This retrospective monocentric observational study included 37 patients. They were matched to 73 patients, who were referred to the Hematology Department, according to age, histology, and Ann Arbor stage. The demographics, clinical and biological presentations, overall survival, and progression-free survival were compared.Patients diagnosed with lymphoma in the Internal Medicine Department were more likely to be febrile (67.5% vs 21.9%; P < .001) and have higher inflammatory markers (mean C-reactive protein 86.6 vs 56.3 mg/L; P = .02). The median overall survival of these patients was poorer (P < .001), even in the subset of patients treated with standard treatment, and remained shorter in multivariable analysis (P = .002). The specific treatment started earlier (20.2 vs 37.5 days; P = .006), but was more frequently palliative (37.8% vs 19.2%; P = .04). There was no significant difference in median progression-free survival.Lymphomas diagnosed in an Internal Medicine Department had aggressive clinical presentations and a poorer outcome, despite an early start of conventional treatment.

Experience of a rapid access falls and syncope service at a teaching hospital in Kuala Lumpur

No abstract available.

Development and content validation of an assessment tool for medicine compounding on hospital wards

Background Medicines should be compounded by using an aseptic technique to assure patient safety. The parenteral administration of microbiologically contaminated doses can result in bacteriaemia, other morbidity and even death. Objective The purpose was to develop and content validate an assessment tool for medicine compounding on hospital wards suitable for self-assessment and external audit to ensure the safety of medicine compounding on wards. Setting Finland as setting. Method The first draft of the tool was based on ISMP "Guidelines for safe preparation of sterile compounds" and a systematic literature search. The tool was validated by using a two-rounded Delphi-method with a panel of 19 experts. Suitability and feasibility of each item was evaluated. Main outcome measure An agreement of ≥70% on each item was required. Results The final tool comprises of 64 items under the following topics: (1) general principles of good compounding practices (23 items), (2) recording and confirming medicine orders on the wards (5 items), (3) storage of medicines on the wards (7), (4) aseptic compounding of intravenous medicines (25 items) and (5) quality assurance (4 items). Most items related to General principles of good compounding practices and Compounding of IV medicines (36 and 38% of the items, respectively). Conclusion It was possible to develop and content validate, by the Delphi method, an assessment tool for safe aseptic compounding on hospital wards. A two-round Delphi process yielded consensus on 64 items for this purpose.

Introduction of digital speech recognition in a specialised outpatient department: a case study

BACKGROUND

Speech recognition software might increase productivity in clinical documentation. However, low user satisfaction with speech recognition software has been observed. In this case study, an approach for implementing a speech recognition software package at a university-based outpatient department is presented.

METHODS

Methods to create a specific dictionary for the context "sports medicine" and a shared vocabulary learning function are demonstrated. The approach is evaluated for user satisfaction (using a questionnaire before and 10 weeks after software implementation) and its impact on the time until the final medical document was saved into the system.

RESULTS

As a result of implementing speech recognition software, the user satisfaction was not remarkably impaired. The median time until the final medical document was saved was reduced from 8 to 4 days.

CONCLUSION

In summary, this case study illustrates how speech recognition can be implemented successfully when the user experience is emphasised.

[The experience of organization of medical care of patients with acute coronary syndrome in multi-type hospital]

In Naberezhnye Chelny, a number of structural and technological reformations of service of emergency medical care was implemented in 2009-2012. The reformation manifested in organization of unified emergency center of medical care of patients with acute coronary syndrome; joining up of cardiological departments of two hospitals; organization of X-ray surgical department; enhancement of logistics of admission department and interaction with emergency medical care; optimization of mode of medical care rendering at pre-hospital and hospital stages. The implemented reforms permitted increasing accessibility and timeliness of reperfusion therapy under acute coronary syndrome; to implement transcutaneous coronary interventions into practice and increase their number annually; to decrease “door-balloon” index up to 30-40%. As a result, lethality of acute myocardium infarction decreased from 12 to 3 to 5.8% in 2010-2014.

[Department of Otorhinolaryngology of the I.P. Pavlov Saint-Peterburg First State Medical University]

This article is designed to report the results of the analysis ofacademic, scientific, and clinical activities of the Department of Otorhinolaryngology of the I.P. Pavlov Saint-Peterburg First State Medical University.

[PRESSURE ULCER AS THE PRINCIPAL INDICATOR OF HEALTH CARE QUALITY AT NEUROLOGY DEPARTMENT]

According to the European Pressure Ulcer Advisory Panel (EPUAP) definition, pressure ulcer is a local skin or subcutaneous tissue damage due to the force of pressure or friction or their combination. Pressure ulcers have accompanied humans since the beginning and respective descriptions are found in the 19th century literature. Pressure ulcer is a major medical, social and health-economic problem because it is associated with a number of complications that require multidisciplinary approach in care and treatment. In affected patients, pressure ulcer causes quality of life reduction, discomforts, pain, emotional problems and social isolation. If the process of tissue decay is not halted, tissue damage will spread involving deep and wider structures, thus seriously compromising the patient general condition. Pressure ulcer usually develops at the sites of protrusions formed by lumbar spine, ischium, hip, ankle, knee or elbow, as well as in the areas with less developed adipose tissue. Any temporary or permanent immobility should be perceived as a milieu favoring the onset of pressure ulcer. Advances in medicine and standards of living in general have prolonged life expectancy, thus also increasing the population at risk of chronic diseases including pressure ulcer. The aim of the study was to determine the relationship between the length of bed-ridden condition and the occurrence of pressure ulcers in patients treated at Department of Cerebrovascular Diseases and Intensive Neurology from January 1, 2012 until December 31, 2015. The study included patients with pressure ulcer verified on admission and those having developed pressure ulcer during hospital stay. Clinical picture of severe stroke predominated in the majority of study patients. Patients were divided into groups according to health care requirements as classified by the Croatian Chamber of Nurses. Preliminary results indicated the length of bed-ridden condition to be associated with the occurrence of chronic wounds, and thus with increased cost and length of hospital treatment. Therefore, health care methods and procedures should be focused on reduction of pressure ulcer development, quality health care, implementation of preventive measures, and continuous education of health care professionals.

Characteristics and temporal pattern of the readmissions of patients with multiple hospital admissions in the medical departments of a general hospital

INTRODUCTION

Patients with multiple hospital admissions represent a small percentage of total hospitalizations but result in a considerable proportion of the healthcare expenditure. There are no studies that have analyzed their long-term clinical evolution.

OBJECTIVES

To study the characteristics, temporal patterns of readmissions and clinical evolution of patients with multiple hospital admission in the long term.

METHODS

A retrospective study was conducted of all hospital admissions in the medical area of the Hospital of Lugo (Spain) between January 1, 2000 and December 31, 2012, based on data from the center's minimum basic data set.

RESULTS

A total of 139,249 hospital admissions for 62,515 patients were studied. Six hospital admissions were recorded for 6.4% of the patients. The overall mortality rate was 16% (9982 patients). The readmissions rate steadily increased with each new admission, from 48% after the first event to 74.6% after the fifth. The rate of hospital readmission before 30days increased from 18.3% in the second admission to 36.3% in the sixth. The number of chronic diseases increased from 3.1 (SD, 2) in the first hospital admission up to 4.9 (2.8) in the sixth. The Department of Internal Medicine treated a third of all hospital admissions. In the sixth hospitalization, conditions associated with admission in Internal Medicine were CIRS score, age, heart failure, COPD, dementia, diabetes, atrial fibrillation and anemia.

CONCLUSIONS

Patients with multiple hospital admissions are complex patients whose temporal pattern of readmissions changes with time, such that each hospital admission constitutes a factor facilitating the next.

[SECONDARY PREVENTION IN PATIENTS WITH ACUTE CORONARY SYNDROME HOSPITALIZED IN INTERNAL MEDICINE DEPARTMENTS]

BACKGROUND

Secondary prevention treatment with aspirin/ clopidogrel, beta blockers, inhibitors of the rennin-angiotensin-aldosterone converting system and statins reduces the morbidity and mortality of patients after acute coronary syndrome (ACS). However, clinical experience suggests that prescription rates in patients hospitalized in internal medicine departments may be low.

AIM

To determine the rate of administration of secondary prevention in ACS patients hospitalized in internal medicine departments; identify predictors for full regimen use and evaluate reasons for non-prescription of the medications.

METHODS

Retrospective review of the files of 399 patients with ACS hospitalized in the 5 departments of internal medicine in a university affiliated medical center in 2010. Data were collected on demographic and clinical parameters, findings on current admission, medications at admission and at discharge, and reasons for nonprescription of secondary preventive medications.

RESULTS

Overall, 62% of patients were discharged with full secondary preventive treatment. In the remainder, the reason for not prescribing the medications was usually not specified. Factors associated with prescription of the "full regimen" were patient receipt of full secondary prevention treatment prior to admission, hypertension, history of myocardial infarction and revascularization, non-ST elevation myocardial infarction as the reason for the current admission, and performance of percutaneous coronary intervention during the current hospitalization. Atrial fibrillation was a negative predictor.

CONCLUSIONS

The prescription of full secondary prevention treatment in ACS patients hospitalized in internal medicine departments is suboptimal. Further efforts are needed to implement comprehensive guideline-based management.

A nurse-driven screening tool for the early identification of sepsis in an intermediate care unit setting

BACKGROUND

Use of a screening tool as a decision support mechanism for early detection of sepsis has been widely advocated, yet studies validating tool performance are scarce, especially in non-intensive care unit settings.

METHODS

For this pilot study we prospectively screened consecutive patients admitted to a medical/surgical intermediate care unit at an academic medical center over a 1-month period and retrospectively analyzed their clinical data. Patients were screened with a 3-tiered, paper-based, nurse-driven sepsis assessment tool every 8 hours. For patients screening positive for sepsis or severe sepsis, the primary treatment team was notified and the team's clinical actions were recorded. Results of the screening test were then compared to patient International Classification of Diseases, Ninth Revision (ICD-9) codes for sepsis, severe sepsis, and septic shock identified during the study time period, and performance of the screening test was assessed.

RESULTS

A total of 2143 screening tests were completed in 245 patients (169 surgical, 76 medical). ICD-9 codes confirmed sepsis incidence was 9%. Of the 39 patients who screened positive, 51% were positive for sepsis, and 49% screened positive for severe sepsis. Screening tool sensitivity and specificity were 95% and 92%, respectively. Negative predictive value was 99% and positive predictive value was 54%. Overall test accuracy was 92%. There was no statistically significant difference in tool performance between medical and surgical patients.

CONCLUSIONS

A simple screening tool for sepsis utilized as part of nursing assessment may be a useful way of identifying early sepsis in both medical and surgical patients in an intermediate care unit setting.

Reorganizing a hospital ward as an accountable care unit

Traditional hospital wards are not specifically designed as effective clinical microsystems. The feasibility and sustainability of doing so are unclear, as are the possible outcomes. To reorganize a traditional hospital ward with the traits of an effective clinical microsystem, we designed it to have 4 specific features: (1) unit-based teams, (2) structured interdisciplinary bedside rounds, (3) unit-level performance reporting, and (4) unit-level nurse and physician coleadership. We called this type of unit an accountable care unit (ACU). In this narrative article, we describe our experience implementing each feature of the ACU. Our aim was to introduce a progressive approach to hospital care and training.

Stroke: subacute/inpatient management of acute ischemic stroke

A stroke unit is a designated hospital area in which patients with stroke are evaluated and treated. Such units have been proven to reduce mortality and disability more than hospitalization in a general medical ward. Diagnostic testing for a patient with stroke includes complete blood count, urine toxicology screening, brain imaging, imaging of neck and cerebral arteries, and cardiac evaluation (including prolonged outpatient rhythm monitoring). Inpatient management should include dysphagia screening and prophylaxis for venous thromboembolism. Lower extremity compression stockings do not prevent venous thromboembolism in stroke patients, but intermittent pneumatic compression devices are of proven value. Patients who do not receive thrombolytic therapy should receive aspirin. A statin should be started if the patient's low-density lipoprotein cholesterol level is 100 mg/dL or higher. Delirium occurs commonly in patients with stroke and more commonly with increased age and stroke severity. Interventions, such as routine oxygen supplementation, prophylactic antibiotics, empiric antipyretic management, and early mobilization, are under investigation. Patients with arterial dissection and patent foramen ovale typically have good prognoses and can be treated medically.

Relationship between in-hospital location and outcomes of care in patients of a large general medical service

BACKGROUND

The discrepancy between the number of admissions and the allocation of hospital beds means that many patients admitted under the care of a general medical service can be placed in other departments' wards. These patients are called 'outliers', and their outcomes are unknown.

AIMS

To examine the relation between the proportion of time each patient spent in their 'home ward' during an index admission and the outcomes of that hospital stay.

METHODS

Data from Flinders Medical Centre's patient journey database were extracted and analysed. The analysis was carried out on the patient journeys of patients admitted under the general medicine units.

RESULTS

Outlier patients' length of stay was significantly shorter than that of the inlier patients (110.7 h cf 141.9 h; P < 0.001).They had a reduced risk of readmission within 28 days of discharge from hospital. Outlier patients' discharge summaries were less likely to be completed within a week (64.3% cf 78.0%; P < 0.001). Being an outlier patient increased the risk-adjusted risk of in-hospital mortality by over 40%. Fifty per cent of deaths in the outlier group occurred within 48 h of admission. Outlier patients had spent longer in the emergency department waiting for a bed (6.3 h cf 5.3 h; P < 0.001) but duration of emergency department stay was not an independent predictor of mortality risk.

CONCLUSION

Outlier patients had significantly shorter length of stay in hospital but significantly greater in-patient death rates. Surviving outlier patients had lower rates of readmission but lower rates of discharge summary completion.

Hospital process orientation from an operations management perspective: development of a measurement tool and practical testing in three ophthalmic practices

BACKGROUND

Although research interest in hospital process orientation (HPO) is growing, the development of a measurement tool to assess process orientation (PO) has not been very successful yet. To view a hospital as a series of processes organized around patients with a similar demand seems to be an attractive proposition, but it is hard to operationalize this idea in a measurement tool that can actually measure the level of PO. This research contributes to HPO from an operations management (OM) perspective by addressing the alignment, integration and coordination of activities within patient care processes. The objective of this study was to develop and practically test a new measurement tool for assessing the degree of PO within hospitals using existing tools.

METHODS

Through a literature search we identified a number of constructs to measure PO in hospital settings. These constructs were further operationalized, using an OM perspective. Based on five dimensions of an existing questionnaire a new HPO-measurement tool was developed to measure the degree of PO within hospitals on the basis of respondents' perception. The HPO-measurement tool was pre-tested in a non-participating hospital and discussed with experts in a focus group. The multicentre exploratory case study was conducted in the ophthalmic practices of three different types of Dutch hospitals. In total 26 employees from three disciplines participated. After filling in the questionnaire an interview was held with each participant to check the validity and the reliability of the measurement tool.

RESULTS

The application of the HPO-measurement tool, analysis of the scores and interviews with the participants resulted in the possibility to identify differences of PO performance and the areas of improvement--from a PO point of view--within each hospital. The result of refinement of the items of the measurement tool after practical testing is a set of 41 items to assess the degree of PO from an OM perspective within hospitals.

CONCLUSIONS

The development and practically testing of a new HPO-measurement tool improves the understanding and application of PO in hospitals and the reliability of the measurement tool. The study shows that PO is a complex concept and appears still hard to objectify.

Successful implementation of a referral-based academic pediatric hospitalist service

OBJECTIVE

St Louis Children's Hospital (SLCH) developed Service for Hospital Admissions by Referring Physicians (SHARP) in January 2008 as an inpatient referral service for pediatricians who previously admitted their own patients. We hypothesized that use of SHARP would make hospitalization more efficient and cost-effective compared with the general pediatric medicine (GM) service.

METHODS

Admission volumes, diagnoses, length of stay (LOS), costs, and physician billing data were abstracted from SLCH information systems and the Pediatric Health Information System database. We compared admissions for SHARP and GM from January 2008 through June 2010.

RESULTS

SHARP had lower LOS and costs versus GM, with no change in 7-day readmission rate. Median LOS was 2 days for SHARP and 3 days for GM (P<.001). Median hospital cost per patient was $2719 for SHARP and $3062 for GM (P<.001). Over the study period, the admission rate increased 37% and daily patient encounters increased 39%. Physician billing revenue increased 25% in the first 6 months, then continued to increase steadily. Total physicians and geographic referral area using SHARP increased, and referring physician satisfaction was high.

CONCLUSIONS

SHARP approaches financial independence and provides a cost savings to SLCH. LOS decreased by a statistically significant amount compared with GM with no change in readmission rate. Referring physician satisfaction was high, likely allowing for growth in referrals to SLCH. SHARP hospitalists' collaboration with referring physicians, ensuring excellent follow-up, provides decreased duration of hospitalization and resource utilization. Our availability throughout the day to reassess patients increases efficiency. We project that we must average 12.6 daily encounters to be financially independent.

Sound decisions. A guide to selecting ultrasound equipment

With so many options on the market, choosing the right ultrasound equipment for your facility can be daunting. This guide will help you navigate the marketplace and choose the best model to suit your needs.

Bringing generalists into the hospital: outcomes of a family medicine hospitalist model in Singapore

PURPOSE

The aim of this study was to assess a newly introduced hospitalist care model in a Singapore hospital. Clinical outcomes of the family medicine hospitalists program were compared with the traditional specialists-based model using the hospital's administrative database.

METHODS

Retrospective cohort study of hospital discharge database for patients cared for by family medicine hospitalists and specialists in 2008. Multivariate analysis models were used to compare the clinical outcomes and resource utilization between patients cared for by family medicine hospitalists and specialist with adjustment for demographics, and comorbidities.

RESULTS

Of 3493 hospitalized patients in 2008 who met the criteria of the study, 601 patients were under the care of family medicine hospitalists. As compared with patients cared for by specialists, patients cared for by family medicine hospitalists had a shorter hospital length of stay (adjusted LOS, geometric mean, GM, 4.4 vs. 5.3 days; P < 0.001) and lower hospitalization costs (adjusted cost, GM, $2250.7 vs. $2500.0; P= 0.003), but a similar in-patient mortality rate (4.2% vs. 5.3%, P= 0.307) and 30-day all-cause unscheduled readmission rate (7.5% vs. 8.4%, P= 0.231) after adjustment for age, ethnicity, gender, intensive care unit (ICU) admission, numbers of organ failures, and comorbidities.

CONCLUSION

The family medicine hospitalist model was associated with reductions in hospital LOS and cost of care without adversely affecting mortality or 30-day all-cause readmission rate. These findings suggest that the hospitalist care model can be adapted for health systems outside North America and may produce similar beneficial effects in care efficiency and cost savings.

Establishment of a stroke unit in a district hospital: review of experience

BACKGROUND

The experience and outcomes of co-locating acute stroke and stroke rehabilitation care in a district hospital were reviewed.

METHOD

Information for patients admitted to Blacktown and Mt Druitt Hospitals before and after setting up an acute stroke unit (SU) (12 months data for each period), including mortality and length of stay (LOS) at the hospital were obtained from various sources, including the diagnosis-related group and subacute and non-acute casemix databases.

RESULTS

There was a significant reduction of mortality (18 vs 10%; P = 0.01) and reduced total LOS (46 vs 39 days; P = 0.01) with similar functional outcomes in the post-SU period. Fifty per cent of patients were unable to access the acute SU. Patients admitted into the SU had lower mortality (5 vs 14%; P = 0.01) and were also discharged from hospital earlier (35 vs 54 days; P = 0.01) than patients admitted into general wards during the post-SU period. Thirty-four per cent of patients received rehabilitation within the rehabilitation facility in the post-SU period compared with 19% in the pre-SU period.

CONCLUSION

The Blacktown experience showed the feasibility of establishing a co-located SU within rehabilitation facility with good outcomes as illustrated by the significant reduction in the stroke mortality, a reduction in the total LOS and an increase in the number of patients receiving rehabilitation post-stroke.

Intravenous drug preparation practices: a survey in a French university hospital

OBJECTIVE

To describe current practices for i.v. drug admixture preparation, to identify potential improvements for the enhancement of patient safety.

DESIGN

A survey was conducted in a University hospital in Paris. Nurse practices were explored through the evaluation of five i.v. drug delivery systems: reconstituted freeze-dried drugs administered by syringe or i.v. bags, reconstituted drugs from vials administered by syringe or i.v. bags Ready to Use (RtU).

PARTICIPANTS

i.v. drug preparation practices were documented by a representative sample of nurses in the following departments: intensive care, emergency, abdominal surgery, cardiology, infectious diseases, hepatology.

MAIN OUTCOME MEASURES

Data were collected regarding: existence of written procedures for preparations, sources of information, labelling, methods of preparation and calculation of doses, nurse satisfaction regarding safety and ease of use of the different i.v. systems.

RESULTS

A total of 299 questionnaires were completed and 100 nurses from the chosen wards were surveyed. The study highlighted a lack of procedure (71-85%) and a lack of labelling (37%).

CONCLUSION

This survey highlighted areas for improvement in the preparation of i.v. drugs. It may contribute to raising awareness among nurses and physicians about the risks of medication errors. This survey also helped the pharmacy department in supporting the development of pharmaceutical procedures, the development of satellite pharmacy, the set up of training sessions for i.v. preparation and the switch toward ready to use packages when these are available.

Effect of an admission monitoring and scheduling system on productivity and employee satisfaction

This article develops and evaluates an admission monitoring and scheduling system designed to reduce fluctuation of work load on nursing units. Effects of the system on work-load distribution, full-time equivalents, labor cost, and employees are assessed in a 235-bed hospital. The system provided more stable work loads and had a potential for improving productivity by about 3 percent, and reducing by about 40 percent the number of days nurses are asked to take off without pay during low-census periods.

Intimate strangers: the role of the hospital chaplain in situations of sudden traumatic loss

Discusses the role of the hospital chaplain in situations of sudden traumatic loss making extensive use of the metaphore of the Stranger. Explicates biblical, theological, historical, and psychological perspectives on the metaphore as it appears within the Judeo-Christian tradition and critically relates this to much current crisis literature. Notes how hospital traumas demonstrate to the chaplain how God's presence may be witnessed in the strange and in ways not always placid or traditional.

Materials management with a bar code reader

A materials management system capable of inventory control, accounting and the automatic recording of supplies for a clinical department has been developed for the George Washington University Hospital Department of Anesthesia. This system combines a microprocessor-based computer for data storage and a hand-held bar code reader to record the bar code scan of each item in the inventory. A relational software program with easy-to-use menus and help keys was written. Bar code information stored for each item includes item number, quantity, date and time of issue. Accumulated bar code scans are loaded into the computer by use of a serial port and then used to update current inventory in the computer. Comparison between current inventory and reorder levels by the computer will initiate automatic printing of appropriate purchase orders. Reorder levels are adjusted regularly, by comparing previous year or month usage to current needs; items already on order, items on back order and delivery lag time are also taken into account.

Problems of medical record storage with an optical disk filing system--with special reference to image quality

An optical disk filing system is a promising new method to memorize the contents of medical records. However, there are some problems of image quality and durability with the disk. The present study investigated the problems with image quality as to the content of medical records. Two optical disk filing systems on the market were used. Medical records of discharge summary, present illness, progress notes, ECGs and polaroid pictures, were put through the image scanner and compared with output images. Image data such as discharge summary and present illness were clearly reproduced with a resolution of 200 dots per inch (dpi). However, polaroid pictures of UCGs or sketches by doctors needed a resolution of 400 dpi with 32-64 gradations. ECGs needed a resolution of 400 dpi with 2 gradations. Records in more than 2 ink colours such as renograms, nurses' notes and doctors' sketches were reproduced in monochrome images, so the colour signals could not be distinguished. In conclusion, the optical disk filing system is useful to store medical records, but it must be improved so as to distinguish colour information.

Managing the medical record on a concurrent basis: facts and possibilities. Part 2

In 1987, six Yale graduate students set out to study the concurrent review methods used in key hospitals across the US. They examined the advantages and disadvantages of concurrent review and the tie-in of medical record concurrent review coding with utilization review activities. The first part of their report appeared in the May issue of JAMRA. The second part appears below.

Data-based accountability: refocusing the medical record professional's role

Changing times, as evidenced by the Health Care Quality Improvement Act of 1986 and the Joint Commission's "Agenda for Change," have made many committees as well as traditional quality assurance and peer review methods obsolete. The new hospital-wide accountability system consists of accurate and valid clinical data, provided in a timely manner, and used effectively by responsible individuals. As has been true over the last 50 years, continuing change does not diminish the important role of the medical record professional. However, the changes do make it necessary for medical record professionals to avoid making themselves vulnerable through obsolescence, by clinging to methodology no longer of merit.

Cost-effectiveness prospects of picture archiving and communication systems

PAC (picture archiving and communication) systems are widely discussed and promoted as the organizational solution to digital image management in a radiology department. For approximately two decades digital imaging has increasingly been used for such diagnostic modalities as CT, DSA, MRI, DR (Digital Radiography) and others. PACS are seen as a step toward high technology integration and more efficient management. Although the acquisition of such technology is investment intensive, there are well-founded projections that prolonged operation will prove cost justified. Such justification can only partly be derived from cost reduction through PAC with respect to present department management--the major justification is preparation for future economic pressures which could make survival of a department without modern technology difficult. Especially in the United States the political climate favors 'competitive medicine' and reduced government support. Seen in this context PACS promises to speed the transition of Health Care Services into a business with tight resource management, cost accounting and marketing. The following paper analyzes cost and revenue in a typical larger Radiology Department, projects various scenarios of cost reduction by means of digital technology and concludes with cautious optimism that the investment expenses for a PACS will be justified in the near future by prudent utilization of high technology.

Effects of the prospective payment system on medical record coding

This article reports upon a study carried out in Alabama to verify if coding functions had actually changed due to PPS as commonly perceived. The study also sought to identify the specific changes in coding procedures and in personnel requirements in that state.