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PubMed1996

[Hospital infections in teaching hospitals: analysis of their control].

The purpose of this study is to identify methodologies of vigilance and hospital infection control, to analyse nurse's actuation in the context of hospital infection control and to associate nurse's actuation on the control of hospital infection and the execution of nursing process. It is an analytic-descriptive study developed at 81 Commissions of Hospital Infection Control (CCIH) at School Hospitals from 21 Brazilian states through a questionnaire. The variables studied were: characteristics and functioning of CCIH; criteria to diagnose hospital infection; methods of data collection; types of epidemiological vigilance, prevention and control measures and nurse's participation. The analysis of data was qualitative and quantitative. The results showed that in the collection of data prevailed general vigilance (66.6%) and the association of passive and active methods (48.4%); 67 CCIH mentioned measures of prevention and control, related to urinary tract (54 CCIH) and to respiratory tract (21 CCIH). The antimicrobian control distinguishing the lack of resonance between the CCIH and the units personnel brings to the conclusion that the problems of hospital infection control are, in their essence, of philosophical, educational or administrative character. Authors evidenced the importance of the implementation of methodologies to facilitate the control of hospital infection, indicating that the adoption of nursing process, as an instrument, can result in benefits to CCIH and to patients.

Brazil↗

PubMed2006

Effect of the new diagnostic criteria for ST-elevation and non-ST-elevation acute myocardial infarction on 4-year hospitalization: an analysis of hospital discharge records in the Veneto Region.

OBJECTIVE: To assess the burden of hospitalization for acute coronary syndrome (ACS) and the impact of the new diagnostic criteria for acute myocardial infarction on epidemiology of ACSs. METHODS: We analysed the hospital discharge record archives of the Veneto Region in the period 2000-2003, including admissions of regional residents outside the study area. We defined a list of ICD-9-CM codes for the identification of different types of ACS. We examined trends in standardized hospitalization rates as well as patient characteristics (age, sex) and pattern of care (setting, invasive revascularization, length of hospital stay, in-hospital mortality). RESULTS: The hospitalization rate for non-ST-elevation myocardial infarction increased by about 70%, with a parallel decrease in hospitalizations for unstable angina, whereas the hospitalization rate for ST-elevation myocardial infarction remained unchanged. These trends are likely influenced by the new diagnostic criteria for acute myocardial infarction. At the end of the study period, although the main patient characteristics did not vary substantially, the pattern of care turned out to be more aggressive. CONCLUSIONS: Despite some limitations, our results indicate that the new diagnostic criteria for acute myocardial infarction have a major impact on epidemiological evaluation. These data may be relevant when comparing epidemiological data of different periods and planning healthcare policies. Further studies are needed in order to evaluate the accuracy of ICD-9-CM codes in the diagnosis of ACSs.

Aged↗

PubMed1998

Texas non-donor-hospital project: a program to increase organ donation in community and rural hospitals.

Identifying and recovering donors from community and rural hospitals present a challenge to organ procurement organizations. A study of non-donor hospitals in the United States was undertaken at Johns Hopkins University, which identified 31 hospitals (in one service area) with the facilities to accommodate organ donation, though an organ donor had not been produced in 3 years. The purpose of this study was to determine whether donors could be produced from these hospitals. A large, geographically dispersed OPO initiated a program consisting of (1) in-house coordinators, and (2) routine notification of all hospital deaths. Following implementation of this program, organ donation increased 387% among the targeted 25 hospitals. The number of hospitals producing at least 1 organ donor increased 133%. The number of organs recovered in the project increased 449%. In-house coordinators, by identifying potential donors and facilitating an organ donor awareness program, can increase the number of organ donors in hospitals with low, but real, donor potential.

Cost-Benefit Analysis↗

PubMedDate not supplied

[Hospital staff use of generic essential drugs: the case of Yalgado Ouedraogo University Hospital Centre (Burkina Faso)].

With the institution of the primary health care strategy in 1978 and the devaluation of the CFA franc in 1994 the French-speaking countries of Africa are striving to encourage the prescription of generic essential drugs. However, their prescription rates continue to remain low in these countries, especially in the major hospitals. The aim of this study was thus to determine how prescribers at the national hospital in Ouagadougou were informed about genetric drugs and to analyse their attitudes and practices with a view to elucidating the barriers to a more widespread use of generic essential drugs in hospital practice. The study consisted of a survey of all of the qualified prescribers (n=194) at Yalgado Ouedraogo University Hospital Centre in 1998. Thirty refused to participate and 35 questionnaires were discarded because they were poorly filled out. So, the responses of 129 (66.5%) prescribers in all were analysed. More than 80% (106/129) of the prescribers were aware of the existence of generic drugs in the hospital, but only 24.8% of them considered generics to have the same efficacy as their corresponding proprietary drugs. However, 64.3% of the prescribers felt that there was a place for generic drugs in a last-resort echelon of medical care, such as the national hospital in Ouagadougou, and 85.3 % were willing to prescribe them for their patients because of their low cost. The analysis of the data and the responses to the open questions show that the main conditions that would boost the prescription of generic essential drugs by hospital staff are as follows: generic essential drugs available in appropriate dosage forms and of guaranteed quality; appropriate basic training starting in medical and nursing schools; providing the prescribers with information and further education about generic drugs; and better dispensing of these drugs by the hospital's central pharmacy.

Adult↗

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↗

PubMed2004

[School in hospital: an opportunity for the hospitalized child to overcome the illness risk].

AIM: The paper reports research on the subject of "Overcoming the illness risk in the School in Hospital service" the aim of which was to monitor this particular service so as to assess whether or not the activities proposed are directed by the model of overcoming inherent risks as defined and reported here. Four research directions were taken to verify the hypothesis whereby the service takes on a supportive-transformative value which enables the hospitalized child to study through his/her illness and is thus able to develop by activating support, protection and diagnosis functions. METHODS: The investigation was carried out using the single case methodology which provided for continuous observation lasting for the entire hospital period in the paediatric wards of 2 hospital in Sicily. The research involved 58 children aged between 7 and 12; chronically ill or long-stay patients, and 100 mothers of hospitalized children. The research also observed the effects of the intervention activated by "School in Hospital" on the child and on his reference models. Various instruments of an observational, projective and psycho-social investigation type were utilized in relation to the 2 main subjects of the research, the development outcomes on the subjects involved and the activities proposed by the service. RESULTS: The overall results confirm the supportive-transformative value of the "School in Hospital" service. CONCLUSIONS: The data obtained suggest that the service should be promoted within hospital structures as a specific form of the caring approach.

Child↗

PubMed2004

Risk factors of job-related depression in laboratory technicians in Hospital Universiti Sains Malaysia (HUSM) and Kementerian Kesihatan Malaysia (KKM) hospitals in Kelantan.

A cross-sectional study was conducted to determine the risk factors of job-related depression in laboratory technicians in Hospital Universiti Sains Malaysia (HUSM) and Kementerian Kesihatan Malaysia (KKM) Hospitals in Kelantan, between September 2001 and February 2002. One hundred and two laboratory technicians from HUSM and 79 from KKM Hospitals were selected and 84 (82.4%) from HUSM and 71 (89.9%) from KKM Hospitals were recruited as study subjects. Data were collected by self-administered questionnaire using the validated Malay version of the Job Content Questionnaire (JCQ), originally developed by Robert Karasek. The results indicated significant associations between the risk factors of job-related depression, and low social support, and high psychological demands (OR 3.0, 95% CI 1.1-8.8) in laboratory technicians in HUSM. However, for laboratory technicians in KKM Hospitals, the significant association was between job-related depression, and low social support and low decision authority (OR 9.7, 95% CI 1.1-91.1). Low social support was highly associated with job-related depression in laboratory technicians in HUSM and KKM Hospitals. We, therefore, conclude that low social support positively predicted depression in laboratory technicians in HUSM and KKM Hospitals. In addition, high psychological demands also significantly predicted depression in laboratory technicians in HUSM; however, for laboratory technicians in KKM Hospitals, low decision authority was the significant predictor of depression.

Adult↗

PubMed1991

The impact of experience with AIDS on HIV testing and counseling practices: a study of U.S. infectious disease teaching hospitals and Minnesota hospitals.

A survey on HIV antibody testing practices was sent to the 200 hospitals in the United States that conduct infectious disease (ID) fellowship training and to all 171 short-term care Minnesota hospitals. Responses were obtained from 124 U.S. ID hospitals (62%) and from 133 (78%) Minnesota hospitals. The U.S. ID hospitals estimated that consent for HIV antibody testing is obtained 70.1% of the time, that consent is both obtained and documented 54.3% of the time, and that risk-reduction counseling in conjunction with such testing is provided 51.4% of the time. The Minnesota hospitals estimated that consent for HIV antibody testing is obtained 35.2% of the time, that consent is both obtained and documented 25.7% of the time, and that risk-reduction counseling in conjunction with such testing is provided 21.8% of the time. Wide variance was noted in both the U.S. and Minnesota responses. Those U.S. hospitals serving higher numbers of persons with AIDS gave higher estimates for each of the 3 items (p less than .05); similar findings were noted among the Minnesota hospitals. The data suggests that standard clinical use of HIV testing remains deficient.

AIDS Serodiagnosis↗

PubMed1987

A community hospital payment experiment outperforms national experience. The Hospital Experimental Payment program in Rochester, NY.

Since January 1980, the hospitals in the Rochester, NY, area have been operating under a community-wide revenue cap. This prospective payment system features local administration and control and is the first time a group of hospitals have committed themselves to a comprehensive regional financing system. This system differs from other prospective payment programs in that it covers both inpatient and outpatient care and offers incentives for ambulatory treatment whenever clinically appropriate. In the first five years of this program, the increase in Rochester area hospital expenses was 46%, compared with 52% for New York State hospitals and 68% for US hospitals at large. Further, the financial position of the Rochester hospitals improved, showing an operating margin of 2.6%, compared with a figure of-15.8% for New York State hospitals at large. A community-wide assessment showed no evidence of a reduction in the quality of or access to care. This community system for hospital payment and planning merits serious consideration for areas wishing to realize high-quality care at an affordable cost through a balanced combination of self-regulation, cooperation, and competition.

Boston↗

PubMed1969

Role of the hospital library within the hospital system.

The results of a survey of hospital administrators, attending staff and house staff physicians, librarians, library committee chairmen, and nursing staff in five Northeastern Ohio hospitals concerning the status of the hospital library within the total hospital system are related. Results indicate that hospital libraries operate in the "fringe" area of the hospital system. A concentric-circle figure indicates the present position of the majority of hospital libraries surveyed. The future relationship of the library within the hospital system has also been represented by a concentric-circle figure.

Hospital Administration↗

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↗

PubMed1994

[Ambulatory operations and day surgery in the hospital--financing from the viewpoint of the hospital].

An hospital's decision to support an outpatient clinic often ignores factors such as staff and management as well as economic data. The immediate or short-term outpatient care procedures require an high level of attention and are exceptionally problematic. The hospital cannot often meet the corresponding technical infrastructure and logistics. The outpatient clinic care basically follows 3 different organizational structures: Hospital-integrated (operates in conjunction with the inpatient business), Hospital-separated (operates in the hospital as an independent station), Satellite-care (operates as an autonomous business entity on the hospital grounds). These organizations have vastly different requirements concerning space resources, financing, and staff. Especially problematic is the lack of financing from government funding for the establishment of necessary building structures and the purchase of technical equipment. Most overlooked in the operation of an outpatient clinic is the effective utilization and availability of the hospital's management and professional staff. It is hard to efficiently manage the hospital's interdisciplinary technical staff that supports the clinic. The economic evaluation of outpatient service is difficult to assess due to a lack of medical quality criteria and binding guidelines on standard compensation and training regulations.

Ambulatory Surgical Procedures↗

PubMed1999

The Bwamanda hospital insurance scheme: effective for whom? A study of its impact on hospital utilization patterns.

The Bwamanda hospital insurance scheme in Zaire was launched in the mid-eighties and is one of the few well-established and documented initiatives in the field of district-based insurance schemes in sub-Saharan Africa. It was established that hospital utilization in Bwamanda is significantly higher among the insured population. A higher hospital utilization is however not a goal in itself: it is a positive phenomenon if it takes place for problems where the hospital's know-how and technology are needed to solve the patient's problem. This paper investigates the effect of the insurance scheme on hospital utilization patterns. More specifically, the distribution of this higher utilization over the different hospital departments, as well as its spatial distribution in the entire district area are analyzed. The impact of the insurance scheme on the effectiveness, equity and efficiency of hospital utilization are discussed. The relevance and possible implications of these findings on the design of the Bwamanda insurance scheme are discussed. Finally, it is argued that the methods used in the present study contribute to a coherent framework for the evaluation of similar initiatives.

Adult↗

PubMed1989

Duration and costs of AIDS hospitalizations in New York. Variations by patient severity of illness and hospital type.

This study uses the Severity Classification for AIDS Hospitalizations to examine and contrast the duration and costs of hospitalizations among 6,142 AIDS discharges from New York hospitals during 1985. Multivariate regression analyses of resource-use differences suggest that more severely ill AIDS patients have considerably longer stays and higher total charges, regardless of hospital type. Severity of illness alone accounts for most of the explained variation in hospital length of stay (LOS) and total charges. In contrast, other patient characteristics, such as gender, race, and reported drug use, are less important predictors of resource use. It was also found that public teaching hospitals serve somewhat more severely ill AIDS patients than those treated in private teaching hospitals. The study concludes that the AIDS severity classification facilitates interhospital comparisons of illness levels and variations in resource use.

Acquired Immunodeficiency Syndrome↗

PubMed1997

Competition, ownership, and access to hospital services. Evidence from psychiatric hospitals.

OBJECTIVES: This article examines the impact of increasing competition among hospitals on access to inpatient services and preexisting differences in access between nonprofit and for-profit facilities. It tests theoretical propositions that suggest that nonprofit and for-profit hospitals will respond in different ways and to differing degrees to changing competitive pressures. METHODS: Drawing data from a 1987-88 national survey of psychiatric hospitals, the authors measured access in terms of the availability of different types of services and the provision of uncompensated care. The impact of hospital ownership, competition as well as the interaction of ownership and competition was assessed through a set of regression models, controlling for other characteristics of the hospital markets and local service system. RESULTS: Nonprofit psychiatric hospitals provide greater access than their for-profit counterparts under conditions of limited competition. Increased competition reduces the ownership-related differences in uncompensated care, but increases the differences for marginally profitable services. The market share of for-profit hospitals had an independent negative effect on access, holding constant the intensity of competition. CONCLUSIONS: The interaction of ownership and competition explains some seemingly inconsistent finding in the literature and points to the complexity of relying on ownership-based policies to protect access in an increasingly competitive health-care system.

Diagnosis-Related Groups↗

PubMed2003

Quality assurance and hospital structure: how the physician-hospital relationship affects quality measures.

Mr. Spaeth writes about the relationship between hospital administration and the physician, and how that relationship affects the quality of medical care delivered to the patient. The article focuses on the differences between the employment structure in an academic teaching hospital, and the open, independent contractor medical staff typical of a traditionally smaller community hospitals. The individual traits and nuances of these structures and how they can be distinguished from one another create dynamic differences in the approach for quality care. Peer review, credentialing, and management of adverse outcomes are just a few of the ways in which hospitals continue to strive to provide higher quality care, but the way these methods are implemented and performed in different hospital structures are dramatically different, yielding distinct results. Mr. Spaeth argues that the challenges faced by community hospitals in their effort to provide higher quality care and eliminate medical error are exacerbated because of their unique structure and the particular relationship physicians share with the hospital and its administration.

Contract Services↗

PubMedDate not supplied

Hospital and community characteristics in closures of urban hospitals, 1980-87.

Characteristics of 190 urban community hospitals that were closed during the period 1980-87 and characteristics of the communities that they served were analyzed and compared to a control group of 380 urban hospitals that remained open. A negative association was found between hospital closure and four hospital characteristics: the presence of a cancer program approved by the American College of Surgeons, the combined characteristics of for-profit status and membership in a multi-institutional chain, the number of admissions, and the number of facilities and services offered. A positive association was found between hospital closure and the percentage of black residents in the community. These findings are discussed in the context of political and economic trends in health care and urban development. Implications for future research are noted, including managerial strategy for hospital administrators and the socioeconomic implications of hospital survival in declining urban communities.

Accreditation↗

PubMed1986

Hospital stay following biliary tract surgery. A comparison of two community hospitals.

An apparent difference in length of postoperative hospitalization following biliary tract surgery at two university-affiliated community hospitals led to a retrospective review of 200 consecutive patients at each hospital. Patient characteristics and surgical practices that potentially affected hospital stay were compared. A highly significant difference was identified in the length of hospitalization between the two institutions. Statistically significant differences in variables that seemed to affect length of stay included the use of nasogastric tubes and abdominal drains and the time interval to the institution of postoperative feedings. Cumulative hospitalization was 517 days shorter at one institution. This was accomplished despite a high percentage of emergent procedures and more frequent involvement of surgical residents. Since hospital stay accounts for the majority of expenditure for surgical treatment of biliary tract disease, shortening postoperative hospitalization can significantly reduce the overall costs.

Adolescent↗