Building a 21st century facility.
At Chicago's Northwestern Memorial Hospital, staff worked for 10 years to design a new facility and plan the transition for their patients, their equipment, and themselves.
Chicago↗
Biomedical subjects
J K Bultema
Publications and source records attributed to J K Bultema.
Characteristics of short-stay admissions to a psychiatric inpatient service.
Since the rapid expansion of managed care coupled with dramatic reductions in lengths of inpatient stay, there is widespread concern that the emphasis on cost containment is eclipsing attention to patient care. The present study was undertaken to evaluate speculations that the majority of short-stay (less than 48 hours) admissions to a psychiatric inpatient service at a large teaching hospital in the midwestern United States consisted of public pay patients who were rapidly transferred to area state hospitals. Using two cases mix measures, severity of illness and changes in acuity and clinical outcomes of a sample of short-stay (n = 77) and longer stay (n = 145) admissions were compared. Short-stay admissions, although similar to longer stay patients in terms of demographics, Axis I diagnosis, payer status, and appropriateness of admission, are clinically distinct. The use of nonhospital alternatives in treating a subsample of suicidal patients and the implications for improved mental health services delivery are discussed.
Adult↗
Geriatric patients with depression. Improving outcomes using a multidisciplinary clinical path model.
Clinical pathways define multidisciplinary staff members' responsibilities, time lines, and patient outcomes. Although medical and surgical care settings frequently use them to improve quality, clinical, and fiscal outcomes for specific patient populations, staff members of psychiatric care settings have been hesitant to use clinical pathways because psychiatry emphasizes patient individuality. The authors describe the development and implementation of a psychiatric clinical pathway for geriatric patients with depression and identify common multidisciplinary interventions and a pattern of outcomes over the course of treatment for these patients. They also delineate quality and fiscal outcomes and future directions. Implementation of the pathway has been successful, and the development and implementation processes have applicability to other patient populations and care settings.
Aged↗
The healing process for the multidisciplinary team: recovering post-inpatient suicide.
1. With an inpatient suicide, the staff may experience grief for a variety of reasons. The staff member's perception of self as a competent mental health care provider may be destroyed. The caregiver may grieve the loss of an ideal. Some inpatient staff members mistakenly believe that suicide can always be prevented and that the multidisciplinary team can accurately assess all patients. 2. To successfully mourn a loss, Worden (1982) identified four tasks of grieving that must be completed: accept the reality of the loss; experience the pain of grief; adjust to an environment in which the deceased or lost object is missing; and withdraw emotional energy and reinvest it in another relationship. 3. Interventions to promote healing post-inpatient suicide must be aimed at individual caregivers and the multidisciplinary team. Individual caregivers will differ in their responses based on experiences, beliefs, values, and culture.
Attitude of Health Personnel↗
Theory, quality, and economy: a winning combination.
To meet quality and cost outcomes, a psychiatric hospital used a combination of strategies based on leadership and system theories. Leadership approaches included credibility, vision, positive self-regard, and communication. Systems initiatives included using reinforcing and balancing feedback loops and shifting the burden structures. This integration of theory, quality, and economy proved to be a winning combination.
Chicago↗