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PubMed2000

[Good clinical practice in using antibiotics in the hospital. Current status in 207 public and private hospitals in 1999].

OBJECTIVES: The purpose of this study was to map activities developed in hospitals to monitor antibiotic usage and evaluate implementation of French guidelines for good clinical practice on use of antibiotics in the hospital setting. METHODS: A questionnaire was mailed to the head of the pharmacy of 300 French hospitals. The questionnaire targeted methods developed to monitor antibiotic usage (antibiotic committees, local recommendations, types of prescription and dispensing, surveillance, information and evaluation activities). RESULTS: The response rate was 69% (207 answers). A local committee supervised antibiotic usage in 49% of the hospitals (nosocomial, drug or antibiotic committees). Local recommendations existed in 120 hospitals (59%) and 42% of the hospitals had a validation process before dispensing drug in accordance with the recommendations. Antibiotic prescription was nominal in 65% of the hospitals and specific monitoring was carried out in 42% of them. Antibiotic consumption was monitored in 80% of the hospitals and resistance was monitored in 53%. Twelve percent of the hospitals used an electronic network to share information on prescription and bacteriological results. Regular internal training existed in 20% of the hospitals and evaluation methods (medical audits, impact measures) in 14%. DISCUSSION: Careful monitoring of antibiotics is implemented in most hospitals. Strict application of guidelines, definition and implementation of indicators, and evaluation methods must be improved. Implementation of better hospital monitoring of antibiotics requires: i) a local consensus to limit the antibiotics available and guidelines to adapt to local infections; ii) dissemination of guidelines and training for prescribers; iii) implementation of a dispensing system to check the validity of prescriptions according to local guidelines; iv) implementation of indicators to monitor bacterial resistance and the volume of antibiotics used.

Anti-Bacterial Agents↗
PubMed2002

[Macroscopic indices of psychiatric hospital functions: evaluation based on data of remaining hospitalized patients].

In recent years, mental health administration in Japan has been changing its orientation from institutional care to community-based care. For this reason, we need new macroscopic indices evaluating psychiatric hospital functions. The most notable indices are data of the remaining hospitalized patients. In this paper, we discuss the macroscopic indices evaluating psychiatric hospital functions focusing on the data of the remaining hospitalized patients. The data are based on a survey of the number of monthly discharged patients who had been admitted to 1,617 psychiatric hospitals in the month of June 1998. The result shows that 1. 70.4% of admitted patients are discharged to communities within a year, 2. 18.3% of patients remain hospitalized one year after admission, and 3. 50% of admitted patients are discharged within 74.2 days. Examination of these data showed it is very useful to evaluate psychiatric hospital functions by categorizing psychiatric hospitals based on the rate of patients remaining hospitalized one year after admission. We also found that "the rate of admissions discharged to communities within a year", "the rate of patients remaining hospitalized after one year", "transition in the rate of patients remaining hospitalized", and "the number of days until 50% of admitted patients are discharged" can be used as effective and practical indices evaluating psychiatric hospital functions.

Community Mental Health Services↗
PubMed1994

Epidemiological study of urinary stones based on operative theater data at regional hospitals and general hospitals of public health region-5, Thailand.

UNLABELLED: A prospective descriptive study of urinary stone patients based on operative theater data of one regional hospital: Maharat Nakhon Ratchasima Hospital and four general hospitals: Chaiyaphum Hospital, Buriram Hospital, Si Saket Hospital, Surin Hospital of the public health region-5 Thailand from October 1992 to June 1993 a duration of nine months was carried out. There were 468 patients (42.7%) from Maharat Nakhon Ratchasima Hospital, 111 patients (10.1%) from Chaiyaphum Hospital, 123 patients (11.2%) from Buriram Hospital, 240 patients (21.9%) from Si Saket Hospital and 155 patients (14.1%) from Surin Hospital. There were 40 patients (3.65%) aged 15 years old or younger and 1,057 patients (96.35%) aged more than 15 years old. 711 patients (64.8%) had renal calculi, 171 patients (15.6%) had ureteral calculi. 190 patients (17.3%) had vesical calculi and 25 patients (2.3%) had urethral calculi. SURGICAL PROCEDURE: Stones were surgically removed -664 patients (60.5%). Nephrectomy -119 patients (10.9%). Basket removed stones -5 patients (0.4%). Cystolitholapaxy -95 patients (8.7%) and ESWL -214 patients (19.5%).

Adolescent↗
PubMed1993

The role of private hospitals in South Africa. Part II. Towards a national policy on private hospitals.

This paper reviews some aspects of present state policy on private hospitals and sets out broad policy guidelines, as well as specific policy options, for the future role of private hospitals in South Africa. Current state policy is reviewed via an examination of the findings and recommendations of the two major Commissions of Inquiry into the role of private hospitals over the last 2 decades, and comparison of these with the present situation. The analysis confirms that existing state policy on private hospitals is inadequate, and suggests some explanations for this. Policy options analysed include the elimination of the private hospital sector through nationalization; partial integration of private hospitals into a centrally financed health care system (such as a national health insurance system); and the retention of separate, privately owned hospitals that will remain privately financed and outside the system of national health care provision. These options are explained and their merits and the associated problems debated. While it is recognised that, in the long term, public ownership of hospitals may be an effective way of attaining equity and efficiency in hospital services, the paper argues that elimination of private hospitals is not a realistic policy option for the foreseeable future. In this scenario, partial integration of private hospitals under a centrally financed system is argued to be the most effective way of improving the efficiency of the private hospital sector, and of maximising its contribution to national health care resources.

Health Policy↗
PubMed2005

Current and future use of ICT for patient care and management in German acute hospitals--a comparison of the nursing and the hospital managers' perspectives.

OBJECTIVES: This study aimed at gaining comprehensive information on the current status of patient care and management applications used in German acute hospitals. Since the degree of ICT coverage in hospitals depends on the attitude of the key decision makers we also wanted to capture their plans and priorities and herewith try to predict future use. METHODS: We therefore conducted a nation-wide survey including all acute hospitals in Germany in which two questionnaires were mailed to each hospital, one to the nursing managers, the other to the hospital managers. RESULTS: Six hundred hospitals participated in the survey which corresponds to an overall response rate of 27.6%. Accounting (84%) was found to be the most prevalent management module. Rostering was implemented in every second hospital. For clinical applications laboratory systems ranked first (69%). Ordering systems were used in nearly every second hospital. Nineteen percent of the hospitals reported employing an electronic patient record, 7% a nursing documentation system. Ranked by their priorities ordering systems hold the first position and care planning the last position. According to their plans, hospital managers, not nursing managers, intend to introduce nursing documentation. In contrast, nursing managers favor ordering and rostering for the near future. CONCLUSIONS: There is still a preponderance of management-oriented systems in German hospitals, yet clinical applications, in particular those supporting communications, will gain ground. The future of documentation systems is unclear, unless they not only provide statistical data for the management but support the clinical process properly.

Attitude of Health Personnel↗
PubMed1981

Outpatient pharmaceutical services in academically affiliated hospitals and selected community hospitals.

The outpatient pharmaceutical services provided by university or medical school-affiliated hospitals and those offered by community hospitals were compared. A questionnaire was sent to a sampling of hospitals that had full-time pharmaceutical services. The hospital pharmacists were asked how frequently they performed 13 patient-oriented services. Four hundred community hospitals from 13 western states and 95 university hospitals nationwide were surveyed. The four null hypotheses tested were: (I) There is no difference between university and community hospitals in mean frequency of patient-oriented pharmaceutical services; (II) the mean frequencies of patient-oriented services are independent of hospital bed capacity; (III) the mean frequencies of patient-oriented services are independent of whether or not clinic outpatients are served by the outpatient pharmacy; and (IV) the mean frequencies of patient-oriented services are independent of the number of full-time equivalent pharmacists employed by the pharmacy. Performance of the 13 patient-oriented services was almost parallel for both the university and community hospitals. The only service that demonstrated a significant difference (p less than 0.05) between the two groups was "prescribing and renewing medication at the request of the physician." The most frequently performed services were to give patients oral medication instructions and drug information for the medical staff. Null hypothesis I was not rejected. A four-way analysis of variance was performed on null hypotheses II, III, and IV; II and III were rejected (alpha less than or equal to 0.05). Nevertheless, a one-way analysis of variance, post-hoc test, and t test revealed that the performance of patient-oriented services was more frequent in hospitals with less than 100 beds and in hospitals that provided outpatient services to clinic patients. Null hypothesis IV was not rejected.

Hospitals, Community↗
PubMed1996

External radiation protection audit in National Health Service hospitals. Radiation protecgtion advisors (RPA) of the Nottingham City Hospital NHS Trust and the Oxford Radcliffe Hospital NHS Trust.

Radiation protection advisers are accustomed to carrying out internal audit in organizations for which they provide services but, traditionally, external audit has not been a part of the radiation protection adviser function. To provide an external audit function, two teams of radiation protection advisers undertook external radiation protection audits of their respective organizations, including the radiation protection adviser function itself. These audits were more representative of audits or inspections carried out by government agencies, for example the Health and Safety Executive and the former Inspectorate of Pollution, now the Environment Agency. Subsequently, reports, including recommendations for remedial action, were prepared for each management by the external auditors. The process of setting up and carrying out the external audits is described. Guidelines are suggested for those seeking to carry out an external audit.

England↗