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Duplicate prescription system to facilitate communication between a hospital pharmacy and community pharmacies.

A duplicate prescription system which enables a university hospital pharmacist to fill a copy of the prescription and return the original prescription to the patient for obtaining continuing supplies in his local community is described. The system is based on a prescription form and carbon duplicate with designated space for notations, and clarifications by the pharmacist. Instructions for use of the form and a statement that the prescription copy cannot be filled legally at any other pharmacy assures that the system will not be misused. The system helps assure that an initial quantity of medication is obtained by the patient before he leaves the hospital. Time spent by patients and prescribers in establishing initial and continuing supplies of medication is decreased under the system. The system is of substantial benefit to patients and health care providers.

Drug Prescriptions↗

Investment in mailroom services produces better communications.

A survey of mailroom practices at Providence Medical Center, Seattle, revealed inadequate working conditions and a lack of supervision. This article explains how careful planning and management enabled the mailroom to control copying costs and to improve services to patients, physicians, and hospital staff.

Copying Processes↗

Communication behaviours in a hospital setting: an observational study.

OBJECTIVE: An exploratory study to identify patterns of communication behaviour among hospital based healthcare workers. DESIGN: Non-participatory, qualitative observational study. SETTING: British district general hospital. SUBJECTS: Eight doctors and two nurses. RESULTS: Communication behaviours resulted in an interruptive workplace, which seemed to contribute to inefficiency in work practice. Medical staff generated twice as many interruptions via telephone and paging systems as they received. Hypothesised causes for this level of interruption include a bias by staff to interruptive communication methods, a tendency to seek information from colleagues in preference to printed materials, and poor provision of information in support of contacting individuals in specific roles. Staff were observed to infer the intention of messages based on insufficient information, and clinical teams demonstrated complex communication patterns, which could lead to inefficiency. CONCLUSION: The results suggest a number of improvements to processes or technologies. Staff may need instruction in appropriate use of communication facilities. Further, excessive emphasis on information technology may be misguided since much may be gained by supporting information exchange through communication technology. Voicemail and email with acknowledgment, mobile communication, improved support for role based contact, and message screening may be beneficial in the hospital environment.

Attitude of Health Personnel↗

An organization-wide approach for an effective communication system, Part 2.

This is the second article in a two-part series that describes an organization's approach to designing, implementing, and evaluating a communication system. Part 1 of this series, published in the March 1998 issue, focused on the design and implementation of this system. This article addresses the evaluation of outcomes related to identified goals to improve communication flow and decision making on multiple levels and to promote accountability for clinical and operational performance. Implementation strategies involving change management, emergence of issues with related implications, and planned evolution of this system also are discussed for ongoing organizational performance improvement.

Hospital Bed Capacity, 500 and over↗

Health information networks: a coming trend?

Within the next five years, technological advances will offer hospitals a wide range of possibilities in communications. If communications systems are to be used properly, health care providers must decide which applications are most appropriate for their purposes, and what responsibilities must be met for their use.

Computers↗

Management of the picture archiving and communications system archive at Texas Children's Hospital.

As hospitals convert from conventional film-based imaging to picture archival and communications systems (PACS), methods for managing an enormous library of images must change considerably. While most hospitals are required to retain general, nonmammographic, radiologic images for 7 years beyond the examination date, our pediatric hospital must maintain images until the child's eighteenth birthday, plus the 5-year statute of limitations. Although the physical extent of an electronic archive is tiny compared with a film archive, a long-range strategy is required to ensure that electronic images acquired today can be retrieved and viewed 23 years in the future. Challenges to the long-term stability of the electronic archive include the limited and uncertain shelf life of high-density electronic storage media, the finite maintainability of the electromechanical systems for reading the media, the short product lifetime of software for accessing the images, rapid development of higher density storage products, and the exponential advancement of computer and networking technology that fuels product obsolescence. Since we cannot assure the function of our current archive in two decades, we are committed to a continual process of migration of old electronic image data to newer media and systems. As an early-adopter of PACS technology, Texas Children's Hospital's (TCH) archive management experience is relevant to others. Although not filled to capacity, our first digital archive, based on phase-change write-once-read-many (WORM) technology, was forced into an inactive status by software and hardware changes. Our second set of archives was partially filled with low-density magneto-optical disk (MOD) media, when the drives were upgraded to high density and then filled to capacity. This undesirable situation forced us into shelf management of media. Our third-generation archive is based on a helical tape library with the capacity to contain 7 years of examinations. We will describe the motivation for data migration, limitations in the methods available to perform the migration, and unanticipated benefits of the migration process.

Computer Communication Networks↗