PubMed · 3633757
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D M Thomas, W A Moses. 1986. Psychiatric nurses develop their own workload measurement system.. https://pubmed.ncbi.nlm.nih.gov/3633757/
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OBJECTIVE: To determine the total and attributable costs of surgical-wound infections in a Canadian teaching hospital. DESIGN: Retrospective incidence series study with chart review and examination of resource utilization attributable to wound infection. The charts of inpatients with wound infections were examined using the Appropriateness Evaluation Protocol (AEP), a validated chart review instrument designed to determine appropriateness of care, modified for wound infections. SETTING: A university referral center in Canada. PATIENTS: Medical records were abstracted from patients with wound infections who underwent an inpatient clean or clean-contaminated procedure during 1991. MEASUREMENTS: During the wound-infection treatment period, the hospital costs associated with providing care were tabulated for all inpatient days and for outpatient and emergency visits. Costs taken into account included nursing salary and benefits, nonphysician professional services, operating room time, laboratory, pharmacy, supplies, ancillary tests, and hotel costs. RESULTS: We identified 108 wound infections. Twenty-two patients required 28 surgical procedures related to a wound infection. Inpatient days totalled 1,116, costing $394,337. Fifty-five emergency and 42 clinic visits occurred, costing $27,193. By applying the AEP to the inpatient days, 833 days, or 10.2 days per case, were directly attributable to the wound infection. The hospital costs for inpatient care attributable to wound infections were $321,533 in total, or $3,937 per infection. Costs were distributed as follows: nursing, 51%; hotel, 14%; pharmacy, 10%; laboratory, 9%; emergency and outpatient clinic, 6%; professional services, 5%; operating room, 3%; and ancillary tests, 2%. CONCLUSIONS: Wound infections contribute markedly to extra days of hospitalization and related costs. The AEP method is applied easily to determine attributable days of care and costs of wound infections, which are necessary to calculate the cost-benefit of infection control programs.
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A peer-review-based continuous quality improvement (CQI) program for improving pharmacists' clinical interventions at a hospital is described. With the implementation of pharmaceutical care at Detroit Receiving Hospital came the need for a CQI system to validate and improve this type of patient care. A peer-review group (PRG) was formed. The PRG decided to review 60 pharmacist interventions per month for clinical appropriateness, accuracy of entry into the computer, documentation in the medical record by the pharmacist, and implementation if accepted by the physician. Interventions are assigned to individual reviewers, and final decisions on the appropriateness and correctness of the selected interventions are made at periodic PRG meetings. In its first year the PRG met nine times and evaluated 409 interventions; 96% of the interventions were judged clinically appropriate, 62% were accurately entered into the computer, 62% were documented in the medical record by the pharmacist, and 92% were implemented if accepted by the physician. Meetings, additional reviews, and inservice sessions were used to address deficiencies in the interventions; these efforts led to improvements. The clinical appropriateness of documented interventions was included as a medication use indicator in the hospital CQI program. A peer-review-based CQI process allowed a hospital to effectively monitor and improve the quality and documentation of interventions recommended by pharmacists.