Information systems in nursing facilities have their own set of requirements. While these may appear to be less complex than those required of acute care systems, they offer their own series of traps and pitfalls and the information systems manager should be wary of vendors who suggest that acute care systems can be readily modified for long-term care usage. Well-designed and implemented long-term care applications demand the same challenges to integration as do acute care products. Information provided by these systems must be designed to support not only the routine transactions of the facility, but also the strategic planning necessary for intelligent management decision making. It is not sufficient in this era to record and replay data. Data must be synthesized into meaningful summaries in order to be effectively used by executives. [7] This is also true for clinicians. Assessment data are increasingly used to position a patient in a case-mix or reimbursement group. Whereas acute care revolves around DRGs and ICD-9 codes (soon to be ICD-10), long-term care uses a patient review instrument (PRI), resident assessment protocols (RAPs), and resource utilization groups (RUGS). The successful information systems manager will have all of these measures at his or her disposal by financial class, insurance class, and days receivable if eyes are kept on the goal of planning all of the systems with equal care and an eye to the future.

Acute Disease↗

PubMed1979

Sinus arrest in diaphragmatic myocardial infarction: treatment of power failure with atrial pacing.

Sinus arrest occurred in a patient with acute diaphragmatic myocardial infarction associated with right ventricular infarction. Cardiac output fell dramatically despite maintenance of a junctional rate of 72. Ventricular pacing at rate 82 and dopamine administration resulted in only slight hemodynamic improvement. Atrial pacing at rate 84 restored normal cardiac output until resumption of sinus node activity. These results suggest that atrial contraction is important for the maintenance of ventricular function in some patients with acute infarction, and may be of particular importance in the presence of right ventricular infarction. Temporary atrial or atrioventricular sequential pacing may be of great hemodynamic benefit in selected patients with conduction defects complicating myocardial infarction.

Cardiac Pacing, Artificial↗