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PubMed2000

Children's response to hospitalization at the University Hospital of the West Indies.

The results of this study indicated that patients aged 3-13 years who had a history of previous hospitalization appeared to be significantly more distressed than patients without such previous history (p < 0.05). Previously hospitalized children were more uncooperative and displayed anxious, immature behaviour patterns. Children who were hospitalized for more than a month were also interviewed about their concerns and response to hospitalization. The study highlighted the need for hospitalized children to be better prepared for hospitalization, to have greater parental involvement in the management of their behaviour and to have efficiently run programmes geared at addressing their educational and emotional needs.

Adaptation, Psychological↗

PubMed2002

Hospital market structure and the behavior of not-for-profit hospitals.

I exploit a change in hospital financial incentives to examine whether the behavior of private not-for-profit hospitals is systematically related to the share of nearby hospitals organized as for-profit firms. My findings demonstrate that not-for-profit hospitals in for-profit intensive areas are significantly more responsive to the change than their counterparts in areas served by few for-profit providers. Differences in financial constraints and other observable factors correlated with for-profit hospital penetration do not explain the heterogeneous response. The findings suggest that not-for-profit hospitals mimic the behavior of private for-profit providers when they actively compete with them.

California↗

PubMed2006

Quality of hospital care evaluated by Danish nurses and doctors--based on experience from their own or a close family member's hospitalization.

INTRODUCTION: No studies have systematically asked larger groups of health professionals about their own experience as patients. This study estimated the level of satisfaction with hospital care among health professionals based on experience from their own hospital admission or that of a close family member. METHODOLOGY: A cross-sectional questionnaire study of 1995 doctors (41% women) and 1472 nurses (98% women) drawn randomly from union registers. Response rate: 70%. RESULTS: Twenty-seven percent had themselves been hospitalized within the preceding five years, and 31% had followed a hospital stay for a close relative during the preceding two years. At least 85% were satisfied with these conditions: information from the hospital, nursing staff, and doctors before admission; quality of the sickroom; level of smoke exposure; quality of breakfast, lunch, and beverages; nursing staff's and doctors' communication with the patient, and; doctors' treatment and diagnostics. Dissatisfaction above 15% was seen for several other factors associated with facilities, care, and treatment. One severe observation was related to the degree of treatment complications, reported by 23% of the patients. When reporting on behalf of an admitted relative a tendency was found to be slightly more critical. Generally, the results of this study are in agreement with previous Danish studies on patient satisfaction. CONCLUSION: The results of the present study indicate room for improvement in several respects in Danish hospital care: Better physical facilities, improved patient information, and a continuous quality surveillance to prevent treatment errors.

Adult↗

PubMed1990

[Cost effectiveness of inpatient hospital care, day hospital care and outpatient consultation in pneumology. Apropos of 162 patients].

The authors report the results of a non-randomised study comparing the efficacy (in terms of confirmation of the diagnosis, the extent of disease, and measurements of airflow obstruction, and of the therapeutic index), and the efficiency in 58 patients suffering from lung cancer as well as 62 patients suffering from chronic airflow obstruction, and 42 asthmatics. These patients were seen in one of three possible services of a respiratory medicine department of a university hospital. The possibilities were inpatient stay in hospital, day hospital, or outpatient consultation. All the patients except one were totally independent, and could be taken into anyone of the three hospital services. The diagnostic efficacy for lung cancer was independent of the type of service used. The day hospital was four times more efficient than inpatient care for lung cancer, and consultation was 3.5 and 4.6 times more efficient than the day hospital for asthma and chronic airflow obstruction respectively. The balance of efficiency and the index of satisfaction experienced by the patients on the service used accentuated these differences.

Ambulatory Care↗

PubMed1987

Quality improvement of patient care: some preliminary results of a hospital-wide quality-assurance project at the University Hospital of Maastricht.

Dutch hospitals have to design their quality-assessment programmes within the boundaries set by "indirect government legislation". At the University hospital of Maastricht a five-stage project was started in 1985 to construct a hospital-wide quality-assurance organisation that includes regular review of the quality of professional performance. This paper will describe intermediate results of the first stage and will discuss the results of different subsurveys undertaken to assess the current level of quality of care and several key-issues conditional to the implementation of such a hospital-wide structure in the existing organisation of a University hospital. Finally the results of the first stage will be contrasted with external legislative standards and internal needs of the University hospital recognised during assessment of the current situation.

Attitude of Health Personnel↗

PubMed1985

Economic regulation and hospital behavior: the effects on medical staff organization and hospital-physician relationships.

New forms of payment, growing competition, the continued evolution of multiunit hospital systems, and associated forces are redefining the fundamental relationship between hospitals and physicians. As part of a larger theory of organizational response to the environment, the effects of these external forces on hospital-medical staff organization were examined using both cross-sectional data and data collected at two points in time. Findings suggest that regulation and competition, at least up to 1982, have had relatively little direct effect on hospital medical staff organization. Rather, changes in medical staff organization are more strongly associated with hospital case mix and with structural characteristics involving membership in a multiunit system, size, ownership, and location. The pervasive effect of case mix and the consistent effect of multiunit system involvement support the need for policymakers to give these factors particular attention in considering how hospitals and their medical staffs might respond to future regulatory and/or competitive approaches.

Certificate of Need↗

PubMed1995

Does the hospital board need a doctor? The influence of physician board participation on hospital financial performance.

In this study, the authors attempted to determine if physician board participation enhances or impairs the operational performance of a hospital. Two theories--managerialism and agency theory--are compared to determine if participation on the hospital board by inside (i.e., medical staff) and outside physicians provides informational advantages (managerialism) or poses the threat for opportunism (agency theory). Using hospital operating margin to measure hospital performance for a 4-year period (1985-1988), the findings indicate that boards with inside physician (medical staff) participation had significantly better performance than those without such physician participation. Supportive of the managerialist perspective, the findings strongly suggest that medical staff board participation can enhance operational performance. Implications of physician-hospital relations for future hospital strategies as well as health care reform issues are discussed.

Data Collection↗

PubMed1988

Organization and operation of the hospital-infection-control program of the University of Iowa Hospitals and Clinics.

The University of Iowa Hospitals and Clinics is located in the center of the United States in Eastern Iowa, has 1,000 hospital beds, and is the largest university owned teaching hospital in the country. Over 35,000 patients are admitted each year. The infection control efforts began in 1969 and were broadened in 1976 with the establishment and implementation of the Program of Epidemiology directed by W.J. Hierholzer, Jr., M.D., hospital epidemiologist. Hospital-wide surveillance is routinely performed by three and a half full-time equivalent LPN practitioners who assess problems and evaluate data essential to realistic identification of nosocomial infection rates, implementation of controls and evaluation of control measures. Nosocomial infection surveillance, utilizing modified CDC criteria, has been performed since July 1976. Ward rounds are made by staff, utilizing nursing care and medication Kardex's, microbiology, hematology and X-ray reports. Importantly, the surveillance system is being validated by concurrent prospective surveys to determine the sensitivity and specificity of reporting data. Outbreaks/epidemics of infections, such as Legionella pneumonia, diarrhea of unknown species, and wounds, as well as burns from manufactured changes in cautery grounds, have been identified and controlled before they have become major epidemics. Surveillance has identified one epidemic per 10,000 patients admitted.(ABSTRACT TRUNCATED AT 250 WORDS)

Cross Infection↗

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↗

PubMed2006

Anemia increases risk for falls in hospitalized older adults: an evaluation of falls in 362 hospitalized, ambulatory, long-term care, and community patients.

OBJECTIVE: The objective of this study was to determine if a relationship exists between the presence of anemia and the occurrence of falls during hospitalization in ambulatory older adults from long-term care and community settings. All individuals were hospitalized for acute conditions not related to a fall. PARTICIPANTS: Three hundred sixty-two hospitalized, ambulatory older (59-104 years) adults. MEASUREMENTS: Laboratory values (hemoglobin [Hb], hematocrit [Hct]), routine laboratory tests, pertinent medical history, and demographics. RESULTS: Ambulatory hospitalized patients who fell were compared to controls (no falls during hospitalization) of similar age (P = .283) and gender distribution (P = .554). Patients who fell had significantly lower Hb (P < .00005), lower Hct (P < .00005) and were more likely to be anemic (56% vs 38%, P = .001) than controls. A logistic regression model examined the effect of Hb level and anemia on falls and included the covariates of age, gender, place of residence, and race. The model described a 22% decreased risk of falls for every 1.0 g/dL increase in Hb (P < .0005) and an overall 1.9-fold increased risk of falls in anemic patients (P < .001). Patient age, gender, and place of residence were not related to the risk of falls during hospitalization. CONCLUSIONS: These findings suggest a potentially important link between anemia and the risk of falls during hospitalization in ambulatory older patients. Further studies are needed to determine if the risk of falls can be modified by correction of anemia and to determine the applicability of these findings to older adults in different settings.

Academic Medical Centers↗

PubMed2003

Utstein style analysis of rural out-of-hospital cardiac arrest [OOHCA]: total cardiopulmonary resuscitation (CPR) time inversely correlates with hospital discharge rate.

OBJECTIVE: Survival after out-of-hospital cardiac arrest (OOHCA) in an urban environment is directly proportional to speed of defibrillation and effective bystander cardiopulmonary resuscitation (CPR). We hypothesized that the hospital discharge rate from rural OOHCA was affected by the same factors. METHODS: We studied all OOHCAs in 1998 for rural Alachua County, Florida, with one emergency medical system (EMS) transport provider and three hospitals. All EMS identified OOHCA were reviewed retrospectively, as were EMS and hospital records. The 1998 County population was 211403; 1495 deaths from all causes occurred (70.7/10(4) pop). Of 167 OOHCAs (7.9/10(4) pop), 145 were of cardiac etiology; 22 were excluded (13 scene deaths, four traumatic, one intraoperative and three respiratory arrests, one arrest during a hospital-to-hospital transfer) and in eight outcome data were not available in any form. A total of 137/145 (94.5%) OOHCA patients had analyzable data. Data were analyzed using Student's t-test and ANOVA. Alpha was set at 0.05. RESULTS: Of 25 patients (18.2% of OOHCA) with restoration of spontaneous circulation (ROSC), six survived (4.4% of total, 24% of those with ROSC) to discharge from hospital (four to a skilled nursing facility, one each home with and without assistance). Four patients were still alive at >or=1 year post arrest. Asystole as the initial rhythm (P=0.014), and emergency department (ED) CPR time (8 vs. 15.5 min, P=0.042 for survivors vs. non-survivors) were the only factors statistically affecting survival. While bystander CPR was not significantly different between groups, there was a significantly higher proportion of patients surviving in the ED who had ROSC, and a higher proportion who had ROSC after bystander CPR. Time to defibrillation in nonsurvivors, while not statistically different between city and county patient groups, was clinically different. Statistical significance would likely have been achieved with a larger study population. CONCLUSION: Our data suggest improvement in response time and bystander CPR might further improve survival in a rural setting.

Cardiopulmonary Resuscitation↗

PubMed2002

Admissions to hospital for deliberate self-harm in England 1995-2000: an analysis of hospital episode statistics.

BACKGROUND: Rates of deliberate self-harm (DSH) were increasing in the United Kingdom during the 1980s and early 1990s, particularly among young adult males. Self-poisoning with paracetamol was the most common means, with overdoses of anti-depressants becoming more frequent. Changes to paracetamol pack size regulations in 1997 have been followed by a reduction in overdoses, and there has been more prescription of anti-depressants less likely to necessitate hospitalization if overdosed. Improved liaison psychiatry services and increased levels of employment are among the factors that would suggest an impact on hospital admissions for self-harm. This study analysed DSH admissions to hospitals in England from 1995/96 to 1999/2000 to examine changes. METHODS: A retrospective analysis of the Hospital Episode Statistics database was carried out. RESULTS: Hospital admissions for DSH rose to 153 per 100000 in 1997/98, then declined to 143 per 100000 in 1999/2000. Paracetamol overdoses decreased from 77 to 67 per 100000. The use of anti-depressants or tranquillizers grew from 56 to 75 per 100000 during the 5 years. Self-injury, narcotics overdoses and the use of alcohol continued to increase over time. CONCLUSIONS: Yearly increases in admissions for DSH to hospitals in England reversed in 1998/99 and stabilized in 1999/ 2000. These changes were most noticeable for the 16-24 years age group. The use of paracetamol decreased, whereas other means of self-harm increased. Regional differences and the relationship between rates of DSH in the community and hospital should be explored further.

Adolescent↗

PubMed1993

The role of oral candidiasis in survival and hospitalization patterns: analysis of an inner city hospital human immunodeficiency virus/acquired immune deficiency syndrome registry.

To assess the effect of oral candidiasis (OC) associated with human immunodeficiency virus (HIV) at initial hospital admission on both survival and hospital use, a retrospective analysis was performed in 1,172 hospitalized patients identified by an HIV surveillance program at an inner city public hospital in East Harlem, New York. Survival times were compared using three different HIV staging schemes placing patients with OC into either a common stage with adenopathy patients (Scheme IHS-URV), a common stage with acquired immune deficiency syndrome patients (AIDS; Scheme WRCDC), or an intermediate stage between AIDS patients and all others (Scheme ORAL). Patients without AIDS demonstrated a significantly increased risk of dying (relative risk, 2.61; 95% confidence interval [CI], 1.69, 4.03) if they were initially admitted with OC. Survival times for different stages of disease showed the best between-stage distinction for a Scheme ORAL, with the OC stage having a median survival of 643 days. Mean days of hospitalization also showed best distinctions for Scheme ORAL. Other staging schemes did not distinguish patients as well in terms of both survival times or mean hospitalization days. HIV-infected patients admitted with OC but without AIDS had a discrete survival prognosis and hospitalization course. Therefore, presence of OC even without other immunologic data has implications for institutional resource allocation and planning. These data support, in this context, a separate clinical designation for OC patients.

AIDS-Related Opportunistic Infections↗

PubMed1998

Overnight hospitalization after radical prostatectomy: the impact of two clinical pathways on patient satisfaction, length of hospitalization, and morbidity.

UNLABELLED: Changes in health care have prompted efforts to reduce length of hospitalization while maintaining quality care. Therefore, we evaluated short-term outcomes after radical retropubic prostatectomy on 100 consecutive men undergoing surgery for clinically localized prostate cancer performed under epidural anesthesia followed by epidural morphine or combined with spinal anesthesia using bupivacaine and fentanyl (25 micrograms) and followed by i.m. methadone (10-20 mg). All patients received oral acetaminophen and ibuprofen beginning 4 h after surgery. Length of hospital stay, responses to written satisfaction survey, postoperative morbidity and readmission to the hospital were recorded. Using either pathway, 83% of the patients were discharged after one night in the hospital. The mean hospital stay was 1.34 +/- 1.10 and 1.28 +/- 1.0 days, respectively. Although three men were rehospitalized, it was not because of the early discharge. More than 95% of patients were satisfied with pain control, and patients discharged after one night were not more likely to be dissatisfied than patients hospitalized longer. IMPLICATIONS: Both clinical pathways provide excellent anesthesia and analgesia and allow discharge 1 day after radical retropubic prostatectomy. Shortened hospital stay does not increase patient dissatisfaction or add to postoperative morbidity. Patients undergoing other pelvic and abdominal operations may also derive similar benefits using these pathways.

Aged↗

PubMed1980

Assessing the outcomes of a home nursing programme: previously hospitalized versus non-hospitalized patients.

This study utilizes four outcome measures to compare the success of a home nursing programme on a group of patients previously hospitalized and a non-hospitalized group. The outcome measures are: mortality, stabilization, hospitalization and nursing home confinement at discharge from the programme. No significant differences were found between the groups, except for nursing home confinement which was higher for the non-hospitalized group. The relationships remained the same even when age and functional status were considered as alternative hypotheses. Implications of this study suggest that home nursing programmes are likely to be as successful with previously hospitalized, as they are with non-hospitalized, patients. Secondly, in evaluating the impact of home nursing programmes on patients, the potential stabilizing influence of the hospital must be taken into account before examining the programme in isolation.

Aftercare↗

PubMed1984

Methicillin-resistant Staphylococcus aureus strains in New York City hospitals: inter-hospital spread of resistant strains of type 88.

A survey of methicillin-resistant strains of Staphylococcus aureus received for phage typing indicated a marked increase of resistant strains received in 1982 and 1983. Of 62 hospitals in New York City which sent strains for phage typing, 35 had methicillin-resistant isolates. A significant development was the presence of strains of the same phage type at several hospitals, indicating a possible inter-hospital spread of these strains. Among strains present at several hospitals, the largest group was of experimental phage type 88. Strains of type 88 were received from 23 hospitals, representing 56% of all methicillin-resistant strains received from New York City hospitals. Strains of type 88 were resistant to all antistaphylococcal antibiotics, with the exception of vancomycin, and represented a major source of nosocomial infections at 13 hospitals. As experimental phage 88 is not routinely used for typing in U.S. laboratories, the nationwide distribution of strains of type 88 is difficult to assess.

Anti-Bacterial Agents↗

PubMed2003

Respiratory syncytial virus bronchiolitis in ex-preterm infants in the Scottish highlands: review of hospital admissions and an analysis of hospital cost.

Ex-preterm infants are vulnerable to respiratory syncytial virus (RSV) bronchiolitis and their hospital admission is associated with increased morbidity. Palivizumab is currently available as prophylaxis against RSV infection but its use in ex-preterm infants is controversial. A retrospective case review study was, therefore, carried out to determine the rate of readmission with RSV bronchiolitis among ex-preterm infants in the Highland Region of Scotland and to estimate the hospital cost per admission. Between 1995 and 1999, a total of 3,046 children under 2 years of age were admitted to Raigmore Hospital, 1,691 of whom (60.4%) lived outwith Inverness. 507 children had acute bronchiolitis and ex preterm infants with RSV positive bronchiolitis accounted for 3.6% of total admissions with acute bronchiolitis. 72% of these children lived outwith Inverness. The median length of hospital stay for children born at less than 30 weeks and for children who had had bronchopulmonary dysplasia (BPD) was 6 and 10.5 days respectively. The average hospital costs per admission for children of less than 30 weeks and children of more than 30 weeks were 3,376 Pounds and 2,074 Pounds respectively. It was more expensive for children with BPD (4,431 Pounds per admission) when compared with those without BPD (1,959 Pounds per admission). This study has shown that most of the children admitted to hospital lived outwith Inverness, many at some considerable distance, and this, as much as severity of illness, may have contributed to hospital admission. Further studies are required to determine productivity losses associated with RSV infection and justification of use of Palivizumab in ex preterm infants of less than 30 weeks gestation and of BPD living in remote areas of Scottish Highlands.

Bronchiolitis, Viral↗

PubMed2004

Unstable angina and non-ST-segment elevation myocardial infarction: part II. Coronary revascularization, hospital discharge, and post-hospital care.

In the guideline developed by the American College of Cardiology and the American Heart Association, the management of suspected unstable angina and non-ST-segment elevation myocardial infarction (UA/NSTEMI) has four components: initial evaluation and management; hospital care; coronary revascularization; and hospital discharge and post-hospital care. Part II of this two-part article discusses coronary revascularization, hospital discharge, and post-hospital care. Decisions must be made about the use of coronary angiography and coronary revascularization in patients hospitalized with UA/NSTEMI. With an early conservative strategy, medical management is employed. Coronary angiography and revascularization are reserved for use in patients with evidence of ischemia at rest (or with minimal activity) and patients with a strongly positive stress test. With an early invasive strategy, coronary angiography and revascularization are recommended within 48 hours in patients without contraindications. Hospital discharge planning involves coordination of medical care, preparation of the patient for resumption of normal activities, and evaluation of the need for long-term risk factor reduction. Discharge medications should be continued to control ongoing symptoms (anti-ischemic agents) and prevent recurrent events (aspirin, clopidogrel, beta blocker, and an angiotensin-converting enzyme inhibitor or statins in selected patients).

Angioplasty, Balloon, Coronary↗