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PubMed1992

Patient satisfaction with hospital services: determinants and level in a hospital in Kuwait.

The present study used a well-tested patient satisfaction measuring instrument to identify the determinants of the level of overall satisfaction with hospital services, and to examine the level of satisfaction with attributes of 7 specific dimensions of hospital services. Using multiple regression analysis, it was found that out of 12 patient characteristics, age was the most important determinant of overall satisfaction, followed by gender. Perceived health status, clinical department, and expectations about the quality of services before admission were also significant but less important determinants of overall satisfaction. Marital status, level of education, nationality, and previous hospitalization in the study hospital, in Kuwait, or in a western country hospital, all had no significant effect on overall satisfaction. Concerning the effect of satisfaction with specific dimensions of hospital services on overall satisfaction, it was found that satisfaction with physicians was the most important determinant of overall satisfaction, followed by satisfaction with housekeeping and with nurses. Satisfaction with hospital environment and facilities and with admission process were also significant but less important determinants of overall satisfaction, while satisfaction with food and radiology services did not affect overall satisfaction. The level of overall satisfaction as well as satisfaction with specific dimensions of hospital services were quite high. Physicians' care was the most favorably rated dimension, followed by admission process and housekeeping, while nursing care was the least favorably rated dimension. Among the attributes of physicians' and nurses' care, technical care and courtesy were the most favorably rated items; while communication, particularly imparting of information, was the least favorably rated aspect. Several attributes of the hospital environment and facilities and of the food services were found to be dissatisfying to patients.

Adult↗
PubMed1979

Multiple hospital systems and the teaching hospital.

A substantial portion of hospital beds are in institutions that are in multiple hospital systems having varying degrees of formal linkage. Relatively few core teaching hospitals are part of such systems, but they do share strong relationships with their parent medical schools and affiliated hospitals. The missions of core teaching hospitals are patient care, education, and research. The traditional affiliation arrangement between hospitals permits the parent university to achieve these missions. The possible benefits to be gained through participation in a multiple hospital system do not appear to be of sufficient magnitude to either core teaching hospitals or their parent universities to persuade them to join or form such a system.

Economics, Hospital↗
PubMed1992

[Ambulatory and day hospital: pediatrics without any time spent in hospital].

The Authors show their six years' experience (1985-1990) in ambulatory activity and day hospital replacing the children's ward in a Lombard Hospital in order to prove the real efficaciousness of the formula "pediatrics without any time spent in hospital". They purpose a nosological framing of the services done in ambulatory and in hospital; they point out the indications for a really favourable use of the day hospital, they report the pathology treated in ambulatory (13,615 examinations) and in day hospital (1,632 admissions to hospital). After six years' experience, the Authors say that "Pediatrics without any time spent in hospital" can really meet most of the sanitary demands of the pediatric population and it is an instrument really improving and not reducing the treatment of the child.

Ambulatory Care↗
PubMed1978

[On the importance of the geographical position of psychiatric hospitals for the admission rates and hospitalization period (author's transl)].

Rates of admission, duration of hospitalization, chances of discharge and legal basis of admissions are analyzed with reference to the distances between the patients' domiciles and the hospital, basing on the figures which apply to the district hospitals Gabersee in Upper Bavaria. More patients from nearby are admitted, and also given long-term treatment, than from the more distant zones; in the long run, chances of discharge are not more favorable for patients living nearby; there is no variation regarding the share of voluntary admissions in relation to the distances between the respective domiciles and the hospital. These results show that there must be increased cooperation between hospitals or wards for inpatients, partial inpatients, and outpatients, in view of the expected increased hospitalization frequency in future psychiatric practice located in the immediate vicinity of the individual districts. Under no circumstances should it happen that instead of the expected saving in the number of hospital beds, the overall capacity of the hospitals is increased.

Geography↗
PubMed1978

Duration of hospitalization for acute bacterial empyema at Boston City Hospital during 12 selected years from 1935 to 1972.

The duration of hospitalization for acute bacterial empyema of the pleura was determined for all cases at Boston City Hospital during 12 selected years between 1935 and 1972. Patients whose infection was acquired after admission stayed in the hospital longer than those in whom the empyema, or the infection of which the empyema was a complication, was present at the time of admission. The differences were mostly related to serious underlying disease in the hospital-acquired cases. However, the duration of hospitalization after the empyema was bacteriologically confirmed was not much different in the community-acquired and hospital-acquired cases. Hospital stay was further prolonged in patients whose empyema was superinfected with new bacterial species after the original infecting organisms were determined. Hospitalization was shorter in the 10 selected years between 1974 and 1972, when penicillin and other active antibiotics were used, than in two years before penicillin became available, 1935 and 1941.

Acute Disease↗
PubMed1976

Conservation in hospital resource use: treatment of pneumonias. An investigation of care in four hospitals over the past decade.

An investigation of patient care in four hospitals compared levels of resource use between 1964 and 1974 for patients with a primary diagnosis of pneumonia. Results showed a decreased length of stay in all hospitals. Unique patterns of increases and decreases existed in each hospital for the changing use of diagnostic and therapeutic resources. Reduction in dollar value of length of stay was larger in all cases than increases in dollar value of diagnostic and therapeutic resource use. This resulted in an overall reduction in hospital resource charges over the decade, when 1974 dollar values were used. Large increases in diagnostic or therapeutic resources (up to 217%) were reflected as only minor increases in the partial hospital bill over the decade ( less than 11%). Increased intensity of resource use has contributed to increasing per-day charges of up to 27%, in the face of recent average cost rises of more than 10 times that size for daily hospital expenses.

Costs and Cost Analysis↗
PubMed1975

Unionization, strikes, threatened strikes, and hospitals--the view from hospital management.

The history of union organizing efforts in the hospital field is discussed in this article, along with the factors judged necessary for successful union organizing. The role played by labor legislation in the unionization of hospital workers is shown, and the influences of the National Labor Relations Act, the Taft-Hartley amendments, and labor legislation at the local level are described. Management has largely resisted unionization because of the social nature of hospitals. Competitive market forces do not confront the not-for-profit hospitals, which are dependent upon third-party reimbursement. While strikes are an integral and essential part of collective bargaining in industry, they are, in fact, detrimental to hospitals because of these institutions' concern with human life. Despite laws and assurances from labor leaders that strikes will not occur, strikes have been used as a method for resolving disputes, through they are basically inconsistent with the economic characteristics and objectives of the hospital. The authors conclude that arbitration awards should be made by arbitrators appointed from outside of the local region of the hospital involved, ant that, because of the catastrophic effect of strikes upon patients as well as employees, arbitration awards should be required, should be binding upon both parties, and should be federally enforced.

Attitude↗
PubMed1978

Bacteremic superinfections of patients with bacteremia: occurrence, bacteriology, mortality, and duration of hospitalization at Boston City Hospital during 12 selected years between 1935 and 1972.

During the course of hospitalization of 6,414 patients with bacteremic infections identified at Boston City Hospital (Boston, Massachusetts) during 12 selected years between 1935 and 1972, 6.0% developed verified bacteremic superinfections with organisms not isolated or identified in the primary bacteremic infection. Analysis of these cases reemphasizes the increasing occurrence of serious hospital-acquired infections despite the successive introduction and intensive use of a large number of effective antibacterial agents. The bacteremic superinfections, like the primary hospital-acquired bacteremias, increased in incidence over the years, particularly since 1961; they were more frequent and were associated with a higher mortality rate and longer duration of hospital stay in the primary hospital-acquired cases than in the patients in whom bacteremia was considered to be community-acquired. The organisms in superinfections were similar to those in primary hospital-acquired bacteremias. Superinfection was more frequent among the patients who died than among the survivors.

Bacterial Infections↗
PubMed1978

Duration of hospitalization for bacteremic infections at Boston City Hospital during 12 selected years between 1935 and 1972.

In survivors of both community-acquired (CA) and hospital-acquired (HA) bacteremic infections at Boston City Hospital during 12 selected years between 1935 and 1972, the mean hospital stay fluctuated widely from one selected year to the next, but it was generally shorter and early discharges were more frequent in the years when effective antibacterial agents were used. The greatest reduction in hospital stay occurred by 1941. The size of the fluctuations and reductions also varied with the causative organism. The average duration of hospitalization of all survivors of HA bacteremic infections after the first positive blood culture was 10.5 days longer than the total hospitalization of survivors of CA infections. The reduced length of hospital stay after 1935 is attributed to the successful use of effective antibacterial drugs, and the greater effect in CA than in HA cases is attributed to more frequent infections in the latter with organisms resistant to those drugs.

Boston↗
PubMedDate not supplied

Strengthening hospital nursing, Part III. Differences among professional groups in the hospital planning process.

Interdisciplinary hospital planning processes are examined. Nurses, physicians, hospital administrators, and support and ancillary personnel from 75 hospitals participating in the national Strengthening Hospital Nursing Program indicate their perceptions of the project in relation to the centrality of the program in their hospitals, planning team development, and political issues. Differences and similarities among the professional groups are discussed. Additional articles on the Strengthening Hospital Nursing Program have appeared in the May and June 1992 issues of JONA. Part 1 explored the planning process in single and consortium hospital sites, and Part 2 examined the characteristics of effective planning processes.

Attitude of Health Personnel↗
PubMed2026

Patient and hospital factors associated with disparities in acute stroke treatment in community and academic hospitals.

BACKGROUND: Systemic barriers may affect identification, emergency transportation (EMS), and care coordination for people with stroke. We assessed patient- and hospital-level factors for associations with pre-hospital and emergency department care. We compared trends for patients presenting to an academic medical center (AMC) versus community hospitals (CHs). METHODS: We conducted a retrospective cohort study at an AMC (Tufts Medical Center) with 542 patients aged ≥18 years hospitalized with acute ischemic stroke or transient ischemic attack between 1/1/2018-12/31/2020 who presented directly to AMC or presented to AMC as a transfer from initial contact CHs. Primary outcomes were EMS use, stroke code activation, door-to-CT time, and door-to-needle time. RESULTS: AMC patients identifying as non-Hispanic Asian (odds ratio (OR) = 0.25; 95% confidence interval (CI) = 0.13-0.47) and Hispanic (OR = 0.19; 95% CI = 0.05-0.72) and CH non-Hispanic Black/African-American patients (OR = 0.17; 95% CI = 0.05-0.62) were less likely to use EMS compared to non-Hispanic white patients. Patients with non-English primary language were less likely to use EMS (OR = 0.38; 95% CI = 0.23-0.63) compared to English-speaking patients in both hospital settings. CH Hispanic patients were less likely to have stroke code activation (OR = 0.24; 95% CI = 0.05-0.86) compared to non-Hispanic white patients. CH patients were less likely to have stroke code activation (OR = 0.12; 95% CI = 0.07-0.19), had 31% shorter door-to-CT time (95% CI = 15-43% shorter), and had 29% longer door-to-needle time (95% CI = 5-58% longer). CONCLUSION: Patient-level factors and hospital setting were associated with differences in acute care suggesting opportunities for community outreach on EMS use, interventions to alleviate language barriers, and a need to address systemic biases.

Humans↗
PubMed1975

Hospital "de-ministration" experiences in six teaching hospitals.

An experimental management programme at Sydney Hospital, first reported in this Journal in 1971, has now been repeated in five other teaching hospitals. These programmes confirm that when professional staff members are encouraged to participate in managing their hospital, they do so very effectively. Results include: better patient care, more patients treated, lower cost per patient, improved morale and flexibility in outlook. The benefits potentially available from the widespread introduction of this approach to managing hospitals are tremendous but to realize them requires radical changes in the way public hospitals are controlled by health authorities.

Accounting↗
PubMed1978

Hospital use of antimicrobial drugs. Survey at 19 hospitals and results of antimicrobial control program.

Costs and use of antimicrobial agents in 1976 at 19 hospitals were surveyed by review of pharmacy records. Total costs of antimicrobial drugs at individual hospitals ranged from $0.65 to $1.75 per patient day and accounted for 16% to 41% of total pharmacy drug costs. There was marked variation among hospitals in use of specific antimicrobial agents, especially cephalosporins and clindamycin. The cephalosporin and aminoglycoside antibiotics accounted for 66% of the total cost of antimicrobial agents. An 18-month antimicrobial drug control program at one hospital decreased antimicrobial drug costs by 31%. The major effect was in reducing cephalosporin use. The results of the control program document that a significant portion of hospital antimicrobial use is inappropriate and can be eliminated without apparent detriment to patient care.

Anti-Bacterial Agents↗
PubMed1976

Hospital staffing and hospital costs.

A comparative study of costs per bed per day in teaching hospitals affiliated with Monash University compared with large non-teaching metropolitan hospitals (1964 to 1974) shows they are much higher in teaching hospitals. There is no evidence that this is due to the additional costs arising from the clinical schools. Research in the teaching hospitals and the accompanying high professional standards and demands on services are major factors accounting for the difference. Over the decade studied, the resident staff have increased by 77% and other salaried staff by 24%. The index of expenditure for the three teaching hospitals in the decade has increased by 386%.

Australia↗
PubMed1992

Information flow in the hospital: a comparative study of the Hungarian and the Dutch situation using a two axes model of hospital information flow.

This study compares the organization and structure of information flow in a Dutch and in a Hungarian hospital. The study was carried out as a field orientation part of a Health Care Management project of the Hogeschool van Amsterdam. The host of the field orientation was the BAZIS Foundation, the Central Development and Support Group Hospital Information System, Leiden. The visited hospitals were equipped with the BAZIS Hospital Information System. The method of study consisted of series of formalized interviews with all-level actors of a hospital; the interpretation of data was enhanced by a two axes (patient and management) model of information flow defined by the authors. In summary, Dutch hospitals show a more elaborate information flow system, with more information flow channels sideways among equal levels, less bureaucracy in organization of information flow, and significantly more benefits of automation, compared to the Hungarian situation.

Computer Systems↗