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At least 73 records · Page 4Linked to original sources

Mishaps during transport from the intensive care unit.

We undertook a prospective study of 125 intrahospital patient transports from the ICU in an attempt to identify any factors that could influence the occurrence of mishaps. One third of the transports sustained at least one mishap. Therapeutic intervention scoring system class IV transports had the highest rate of mishaps (35%). We found no relationship of occurrence of mishaps to severity of illness (Acute Physiology and Chronic Health Evaluation, APACHE II), number of lines, monitoring and support modalities, and time out of the ICU. Transports for elective procedures had more mishaps (60%) than occurred for emergencies (40%). Most mishaps occurred either during the procedure, on transports to CT scan, or while waiting at the destination. The numbers and types of escorts as defined by our ICU policy and physician attendance on transport did not clearly reduce mishap risk. Morbidity and mortality were not affected by mishaps. Although certain trends did emerge, no clearly defined predictive factor could be identified. Further study into transport mishaps is warranted.

Accidents↗

Introducing a quality of service programme to hospital orderly staff.

Recent reshaping of health provision throughout New Zealand has brought many changes to virtually every area of the service. In some instances this has required a totally fresh approach with a different way of thinking. In others, it has meant the adaptation and remodelling of existing structures and approaches. This paper gives a brief overview of the West Auckland Health District Quality of Service Programme and, in particular, its introduction to the orderly service at Waitakere Hospital.

Job Description↗

Simulation of a hospital's theatre suite.

Describes a study of sex operating theatres in a modern hospital where management was concerned about the throughput of the system. Senior medical staff were of the opinion that insufficient recovery spaces had been provided when the suite of theatres had been built which, if correct, was a physical constraint requiring considerable financial investment to remedy. They also thought that shortage of porters (¿You can never find a porter when you need one!¿) and recovery nurses were current operational problems. The relationship issues encountered when interfacing with the staff involved, the collection and analyses of relevant data and the building of a visual interactive simulation model are described.

Anesthesiology↗

Transporting acutely ill patients: a framework for radiology.

Concern grew at Ms. Doherty-Simor's institution about the proper care and monitoring of inpatients traveling to the radiology department for exams after-hours and on weekends, when radiology nurses were not usually available. In this article, she reports on the findings of a special task force, proposed solutions and the resultant improvements to patient care.

Guidelines as Topic↗

Total quality management at Bethesda, Inc.

This article describes 4 years of TQM implementation at Bethesda, Inc., a private not-for-profit diversified healthcare organization. Bethesda has used a comprehensive implementation strategy involving the use of process improvement teams, hoshin planning, daily management of critical processes, and quality function deployment. The article includes four process improvement case studies demonstrating the use of the seven quality control tools and a nine-step process improvement model. Factors contributing to processes as well as obstacles are described.

Ambulatory Surgical Procedures↗

Rising to the challenge: portering services at the Queen Elizabeth II Health Sciences Centre.

With the recent formation of the Queen Elizabeth II Health Sciences Centre in Halifax, Nova Scotia, a number of challenges have arisen that must be addressed. One involves the porter service, which faces increased demands since every department has new and often expanded duties for porters. This paper identifies obstacles facing the porter service and develops recommendations, which may also be of interest to other healthcare facilities facing similar challenges.

Health Facility Merger↗

Quality care means valuing care assistants, porters, and cleaners too.

All too often, the focus of the very clever strategy papers produced in the upper reaches of the health department is on the next grand plan. Some of these reforms have been catastrophic for the quality of service that patients experience at ward level. Of these, the contracting out culture introduced in the 1980s and the 1990s has been the worst. Researching my book, Hard work-life in low pay Britain, I took six jobs at around the minimum wage, including work as a hospital porter, as a hospital cleaner, and as a care assistant. These are jobs at the sharp end, up close and very personal to the patients, strongly influencing their experiences of the services they were using. Yet they are low paid, undervalued jobs that fall below the radar of the policy makers. In hospitals they need to be brought back in-house and integrated into a team ethos. Paying these people more would cost more, but it would also harvest great rewards by using their untapped commitment.

Health Personnel↗

A computerized dispatch system that really delivers.

In 1990, Victoria Hospital in London, Ontario undertook a review of its Central Portering Department. The department's name was changed to Distribution Services and its need for more efficient servicing of customers led to the search for a computer system to replace the manual dispatch operation. After failing to find an existing system, the hospital contracted to develop its own system, called Vic Tracker. The system categorizes and prioritizes requests and produces various activity reports. Response time has improved 50% on average, and improved efficiency and a pre-booking feature has resulted in a decrease of approximately 100 calls per day.

Computer Systems↗

Interruption of oxygen therapy during intrahospital transport of non-ICU patients: elimination of a common problem through caregiver education.

UNLABELLED: Hospital inpatients frequently leave their rooms for diagnostic procedures and for other reasons. For some, interruption of oxygen therapy during transport could lead to serious complications. In our institution, non-ICU patient transport is done mainly by nonclinical personnel from an independent transport service. MATERIALS & METHODS: We reviewed respiratory care department and transport service records for 5 arbitrarily selected days to determine the number of non-ICU patients receiving O2 therapy, the number of times these patients were transported, and the number of occasions on which O2 was used during the transport. We then interviewed the primary nurse for each patient transported without O2 and reviewed the charts of those patients to determine whether this practice was consistent with the therapy as it had been ordered. After our initial investigation showed a high rate of transport without prescribed O2, we sent memoranda to all nursing units describing proper procedures for transport of patients for whom O2 had been ordered. We then repeated the audit. Because the second audit showed the need, we conducted education sessions with all nursing personnel on the affected units and posted guidelines for O2 use during transport. A third audit was then conducted. In addition, we performed a telephone survey of respiratory care department managers to learn the patient-transport practices in all hospitals in our state with more than 200 beds, using a structured questionnaire. RESULTS: During the initial 125 patient-days of O2 therapy, O2 accompanied patients on only 30 of 55 transports (55%). After distribution of memoranda, O2 use increased to 28 of 35 transports (80%) during 82 patient-days. The second educational effort resulted in O2 use with all 35 transports (100%) performed during 99 patient-days. Survey results from 24 hospitals with 225-680 beds showed that 11 (46%) had separate transport services and that decisions on O2 use during patient transport were generally made by nursing staff. Although respiratory care departments supplied the O2 equipment, their personnel were involved in non-ICU transports in only 5/24 hospitals. CONCLUSIONS: Patients receiving O2 therapy on acute-care wards are often transported to other areas of the hospital without O2. This potentially dangerous practice can be corrected by respiratory care practitioners through educational efforts targeted toward those responsible for administering O2 therapy in non-ICU hospital areas.

Continuity of Patient Care↗

Effects of activity-rest schedules on physiological strain and spinal load in hospital-based porters.

Workers in physically demanding occupations require rest breaks to recover from physiological stress and biomechanical loading. Physiological stress can increase the risk of developing musculoskeletal disorders and repeated loading of the spine may increase the potential for incurring back pain. The aim of the study was to assess the impact of an altered activity-rest schedule on physiological and spinal loading in hospital-based porters. An existing 4-h activity-rest schedule was obtained from observations on eight male porters. This schedule formed the normal trial, which included two 5- and one 15-min breaks. An alternative 4-h schedule was proposed (experimental condition) that had two breaks each of 12.5 min. It was hypothesized that the experimental trial is more effective in promoting recovery from physiological strain and spinal shrinkage than the normal trial, due to the 5-min breaks being insufficient to allow physiological variables to return to resting levels or the intervertebral discs to reabsorb fluid. Ten males performed both test conditions and oxygen uptake VO2, heart rate, minute ventilation VE, perceived exertion and spinal shrinkage were recorded. There were no significant differences in any of the measured variables between the two trials (p > 0.05). Median heart rates were 78 (range 71-93) and 82 (71-90) beats.min(-1) for the normal trial and the experimental trial respectively, indicating that the activity was of low intensity. The light intensity was corroborated by the oxygen uptakes (0.75, range 0.65-0.94 1.min(-1)). Spinal shrinkage occurred to the same extent in the two trials (2.12 +/- 3.16 mm and 2.88 +/- 2.92 mm in the normal trial and the experimental trial respectively). Varying the length and positioning of the rest breaks did not significantly affect the physiological responses or magnitude of spinal shrinkage between the two trials. More physically demanding work than the porters' schedule should induce greater physiological fatigue and spinal shrinkage. The ratio between activity and rest breaks would then become more important.

Adult↗

Presence of family member during upper endoscopy. What do patients and escorts think?

We evaluated what effect an escort present during upper endoscopy had on the attitude and anxiety level of patients and on the escorts. The study consisted of 206 patients (ages 15-85, 47% male) and their escorts. Both patients and escorts were interviewed before the procedure. Escorts were then randomly divided into two groups-on-the-spot escorts, who present throughout the procedure, as opposed to waiting-room escorts. Both groups were reinterviewed following the procedure. Before the procedure, 80% of the patients understood the nature of endoscopy. Thirteen percent believed the procedure to be dangerous, and only 33% were totally worry-free. Fifty percent preferred to be escorted during the procedure, while 17% refused. Following the procedure, 89% of the patients who were escorted in the endoscopy room expressed satisfaction. Fifty-two percent of the patients found the procedure to be mild, with a higher proportion among escorted patients. Among the escorts, 63% felt that their close presence had lessened their own fears and anxiety regarding the procedure, and 72% believed their presence to have been supportive to the patient. Having an escort present throughout endoscopy appears to be a promising approach.

Adolescent↗