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PubMed1991

The evaluation of an intermediate care--geriatric evaluation unit in a Veterans Administration Hospital.

In response to the increasing care needs of geriatric patients and attendant hospital costs, the Nashville Veterans Administration Medical Center, which has 393 beds and admits 8400 patients annually, initiated an Intermediate Care Service in 1988. A geriatric team was formed, sharing staff and resources from existing units. To determine the efficacy of intermediate care, automated data sources at the Nashville Veterans Administration Medical Center provided data on discharge status, length of stay, and diagnoses of patients in both the acute and intermediate care units. The first year's experience indicated that careful communication and education of nursing staff was required to initiate the Intermediate Care Service with no staff resigning. An interdisciplinary team facilitated better patient care and discharge planning. Among 190 patients discharged from this service, 57% were discharged home and 22% into nursing homes; this can be compared to those discharged from acute care units of the hospital: 84% home and 4% to a nursing home; 20% of the patients in the Intermediate Care Service were discharged to a lower level of care than the initial hospital discharge plan had indicated. A 1.4-day decrease in average length of stay in the hospital has occurred since initiation of the Intermediate Care Service.

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PubMed1995

A hospital administrator's view of the operating room.

The need for greater efficiency in OR management will become apparent as hospitals are forced to respond to a myriad of pressures imposed by the external environment. The most effective strategy in dealing with this challenge will be realized by adopting a "systems" approach to OR functions as opposed to the more traditional methodology that emphasizes a review of individual problematic components. One issue that challenges many ORs is "throughput": the backlog of patients in ORs that occurs because the recovery room is filled to capacity. The traditional approach is to focus on the recovery room's inefficiency and to expend energy on improving recovery room function. A "systems" approach would examine all factors that affect recovery room function and analyze the interdependencies that exist between the recovery room and other hospital service functions. These might include the way cases in the OR are scheduled, as well as issues that involve patient transfer from the recovery room to intensive, intermediate, and routine floor care. By establishing a dialogue with parties outside of the traditional OR community, the opportunity to solve problems that affect the OR but that are outside of its direct sphere of control, presents itself. This approach will require the acquisition of new skills by those responsible for OR management in addition to promulgating a change in the culture that dominates many ORs today. An insular approach that reinforces the concept of the OR as a microcosm unto itself is an outmoded one. The hospital community at large will benefit from the expert skills possessed by those proficient in efficient OR management, while enabling the OR to fulfill its mission in the challenging times ahead.

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