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PubMed1995

Maternity and parental leave policies at COTH hospitals: an update. Council of Teaching Hospitals.

Because residents' demands for parental leave are increasing, updated information about maternity and paternity leave policies was solicited from hospitals that are members of the Council of Teaching Hospitals (COTH) of the AAMC. A 20-item questionnaire, combining forced-choice categories and open-ended questions, was faxed to 405 COTH hospitals in October 1994; 45% responded. A total of 77% of the respondents reported having written policies for maternity and/or parental leave; in 1989, only 52% of COTH hospitals had reported having such policies. Forty-one percent of the 1994 responding hospitals offered dedicated paid maternity leave, with a mean of 42 days allowed. Twenty-five percent of the respondents offered paternity leave, and 15% offered adoption leave. It is encouraging that the majority of the teaching hospitals that responded to the survey had adopted written policies, but the 23% without written policies remain a source of concern. Well-defined policies for maternity, paternity, and adoption leave can reduce stress and foster equity both for trainees requiring leave and for their colleagues.

Female↗

PubMed1998

Physician-hospital integration strategies: impact on physician involvement in hospital governance.

This study investigated the impact of three physician-hospital contractual arrangements (PHCAs)--joint ventures, management service organizations, and not-for-profit foundations--on physician involvement in hospital governance and physician-hospital relationships. Analysis of data collected from a national sample of 1,013 hospitals revealed that PHCAs generate greater physician involvement in hospital decision making and result in lower physician-hospital conflict.

Budgets↗

PubMed1995

In-hospital cardiopulmonary resuscitation. Survival in 1 hospital and literature review.

Cardiopulmonary resuscitation (CPR) has been used extensively in the hospital setting since its introduction over 3 decades ago. We reviewed the CPR records at 1 hospital during a 2-year period and the results from 113 published reports of inpatient CPR with a total patient population of 26,095. We compared the survival rates of patients following CPR and the pre-arrest and intra-arrest factors related to survival. At the hospital where CPR records were reviewed, 44% of patients initially survived following CPR, and the 1-year survival rate was 5%. Patients with shorter durations of CPR and those administered fewer procedures and medications during CPR survived longer than patients with prolonged CPR. Patients with witnessed cardiac arrests were more likely to survive than those with unwitnessed arrests. Also, patients with respiratory arrests had much better survival than patients with cardiopulmonary arrests. Worldwide, 113 studies showed a survival to discharge rate of 15.2% (United States = 15%, Canada = 16%, United Kingdom = 17%, other European countries = 14%). Patients were more likely to survive to discharge if they were treated in a community hospital (versus a teaching or Veterans Affairs hospital) or were younger. Patients with ventricular tachycardia or fibrillation were more likely to survive than those with asystole or electromechanical dissociation. Patient's location was related to outcome, with emergency room and coronary care unit patients more likely to survive than intensive care unit and general ward patients. Other factors related to better survival rates were respiratory arrest, witnessed arrest, absence of comorbidity, and short duration of CPR. Knowledge of the likelihood of survival following CPR for subgroups of the hospital population based on pre-arrest and intra-arrest factors can help patients, their families, and their physicians decide, with compassion and conviction, in what situations CPR should be administered.

Adult↗

PubMed2000

A randomised controlled trial of the costs of hospital as compared with hospital in the home for acute medical patients.

OBJECTIVE: To test the cost effectiveness of Hospital in the Home compared to hospital admission for acute medical conditions. METHOD: Randomised controlled trial at the Prince of Wales Hospital, Sydney, from October 1995 to February, 1997; 100 patients with acute medical conditions admitted through the Emergency Department. RESULTS: The Hospital in the Home (HITH) group costs per separation ($1,764, CI 95% $1,416-$2,111, n = 50) were significantly lower (p < 0.0001, Mann-Whitney U-Wilcoxon Rank Sum) than the control group hospital separation ($3,614, CI 95% $2,881.37-$4,347.27, n = 47) with no significant difference in clinical outcomes, and comparable or better user satisfaction. CONCLUSION: Given the favourable clinical outcomes the HITH model produces at a lower cost, the cost-effectiveness of the care mode is high, and the allocative efficiency favourable. IMPLICATIONS: As a care model and critical pathway, HITH offers hospitals real bed day savings that can either be used to rationalise resource usage for a given level of activity, or increase throughput.

Acute Disease↗

PubMed1993

[Hospital infection with methicillin-resistant Staphylococcus aureus (MRSA) in Saga Medical School Hospital, a rapid increase in coagulase type-VIII strains].

Hospital infection with MRSA has increased in Saga Medical School Hospital. The causative MRSA consisted predominantly of coagulase type-II strain before 1989, but after 1990, coagulase type-VII MRSA increased rapidly. This type-VII strain has marked multiple drug-resistance, and the pattern of drug sensitivity of MRSA in this hospital was different from that of MRSA detected in other facilities, which are clinically serious problems, therefore, we conducted an etiological study of the background of the increase in MRSA infection in our hospital. The results of the study are summarized as follows: 1) The proportions of MRSA (on strain from one patient) to all types of S. aureus detected in the hospital were 26% for 1986, 23% for 1988, 37% for 1989, 30% for 1990 and 60% for 1991. The proportion increased greatly in 1991. 2) Coagulase type VII-MRSA was first detected only in 5 patients in 1989, then it tended to spread, and this type (probably derived from the same strain) accounted for 47% of MRSA infection in patients examined in 1991. 3) The study of the drug sensitivity pattern and etiological survey of the infection showed that coagulase type VII-MRSA prevalent in the hospital consisted of two types: CLDM, and EM-sensitive, IPM/CS, and MINO-resistant and TSST-1 non-producing and enterotoxin non-producing type, and CLDM, and EM-sensitive, IPM/CS, and MINO-resistant and TSST-1 non-producing type with enterotoxin serotype A. 4) Coagulase type VII-MRSA (Probably derived from the same strain) was detected in physicians and nurses working in affected wards and also in the patients's room.(ABSTRACT TRUNCATED AT 250 WORDS)

Coagulase↗

PubMed2000

HIV infection and in-hospital mortality at an academic hospital in South Africa.

AIM: To document the impact that rapid increases in HIV infection in hospitalised children at Chris Hani Baragwanath Hospital has had on in-hospital mortality. METHODS: Hospital discharge summaries from January 1992 to the end of 1996 were reviewed. RESULTS: There were 20 733 admissions in the five year period; 7985 (39%) were tested for HIV. In tested admissions above 15 months of age, 4.9% were HIV infected in 1992, increasing to 35% in 1996. Under 15 months of age, 9% of tested admissions were positive in 1992, increasing to 46% in 1996. The proportion of all hospital deaths occurring in children considered HIV infected (ELISA testing together with clinical features if 15 months or younger) increased from 6.7% in 1992 to 46. 1% in 1996 (p < 0.001). In-hospital mortality for all children increased by 21% from 4.3% in 1992 to 5.2% in 1996. Mortality rates declined in uninfected children from 5.4% in 1992 to 4.5% in 1996 (chi(2) trend 3.3; p = 0.06). CONCLUSION: The mortality rate of children has increased at Chris Hani Baragwanath Hospital as a result of HIV infection. Almost half the deaths were HIV related in 1996. HIV infection is threatening the advances that have been made on child survival in South Africa over the last few decades.

Age Distribution↗

PubMed2002

Randomised controlled trial comparing an acute paediatric hospital at home scheme with conventional hospital care.

AIMS: To assess the clinical effectiveness of a paediatric hospital at home service compared to conventional hospital care. METHODS: A total of 399 children suffering from breathing difficulty (n = 202), diarrhoea and vomiting (n = 125), or fever (n = 72) were randomised to Hospital at Home or in-patient paediatric care. Main outcome measures were: comparative clinical effectiveness as measured by readmission rate within three months (used as a proxy for parental coping with illness); and length of stay/care and comparative satisfaction of both patients and carers. RESULTS: Clinical effectiveness of both services was not significantly different. Length of care was one day longer in the Hospital at Home group; however, most parents and children preferred home care. CONCLUSIONS: Hospital at Home is a clinically acceptable form of care for these groups of acute paediatric illness. Readmission rates within three months failed to show any advantage in terms of parental coping. Parents and patients expressed a strong preference for hospital at home.

Acute Disease↗

PubMed1989

Physician use of hospitals: effects of physician, patient, and hospital characteristics.

This paper examines the determinants of hospital utilisation in one county. In contrast to previous studies, the paper examines the physician rather than the patient as the key decision-maker. Specifically, the paper assesses the impact of several physician, patient, and hospital characteristics on the probability of admitting to a hospital, the volume of the physician's admissions at the hospital, and the concentration of the physician's admissions at the hospital. Distance from the physician's office to the hospital exerts the strongest and most consistent effects. The results are interpreted in light of several theoretical and research perspectives on physician behaviour.

Age Factors↗

PubMed1999

[Mortality risk factors in patients over 65 years of age hospitalized in a São Paulo, Brasil university hospital].

Various studies show that age in itself is not an independent predictive factor for the survival of critically ill older persons. In spite of that fact, people over 65 tend not to have access to the most-sophisticated diagnostic and therapeutic resources. With the continued aging of the population, it is increasingly important to be able to determine the mortality risk factors that affect the survival possibilities of hospitalized older people, especially in emergency situations. The objective of this study was to analyze the risk factors related to mortality among people over 65 admitted to the emergency service of the Santa Casa Hospital of São Paulo, a third-level academic institution. The study was based on a nonconditional logistic regression analysis of personal data in the clinical histories and other documents of the hospitalized patients. From July 1993 through March 1994, 599 patients over 65 were hospitalized. They included 326 men (54.4%) and 273 women (45.6%), with a median age of 73.3 years. The primary reasons for admission were pneumonia (14.4%), cerebrovascular disease (11.5%), and congestive heart failure (8.2%). There were 160 deaths among the group. Those who died had a median stay in the hospital of 4 days (range, 1 to 72), which was similar to that of those who survived (median, 3 days; range, 0 to 35 days; P = 0.29). According to multivariate analysis, factors predictive of survival were hypertension (odds ratio = 0.39; 95% CI: 0.23 to 0.68), chronic obstructive pulmonary disease (OR = 0.45; 95% CI: 0.22 to 0.95), and diabetes mellitus (OR = 0.50; 95% CI: 0.27 to 0.91). This was true regardless of sex, age, race, compliance with treatment, initial diagnosis, and other pathological conditions present. On the other hand, two factors were predictive of mortality during hospitalization. They were the presence of extrapulmonary infections (OR = 2.34; 95% CI: 1.13 to 4.86) and the number of preexisting illnesses: one (OR = 2.78; 95% CI: 1.56 to 4.96), two (OR = 4.56; 95% CI: 2.28 to 9.15), and three or more (OR = 15.88; 95% CI: 6.49 to 38.85). This study shows that improving the diagnosis and treatment of infections can reduce mortality of elderly persons admitted to emergency services. Rather than age, the multiplicity of diseases was the factor that increased the risk of death among these patients. There is no justification for using age alone to limit the access that older patients have to better diagnosis and treatment resources, if these resources can result in better survival rates, fewer disabilities, or a better quality of life.

Aged↗

PubMed1997

Weak associations between hospital mortality rates for individual diagnoses: implications for profiling hospital quality.

OBJECTIVES: This study examined the consistency of hospital mortality rates across different diagnoses. METHODS: Standardized mortality ratios for patients discharged in 1991 from US hospitals were determined via the Medicare Hospital Information Report. RESULTS: Correlations between standardized mortality ratios for different diagnoses were relatively weak, ranging from .03 to .34. Agreement between hospital rankings (based on standardized mortality ratios), as measured by the weighted kappa statistic, was also weak. CONCLUSIONS: The present results indicate that hospital mortality rates for individual diagnoses are weakly associated. Thus, it may not be valid to generalize conclusions about hospital performance from a single diagnosis.

Coronary Artery Bypass↗

PubMedDate not supplied

The increasing burden of infectious diseases on hospital services at St Mary's Hospital Lacor, Gulu, Uganda.

To evaluate the impact of infectious diseases on hospital services in Northern Uganda, a retrospective analysis of discharge records concerning 70,304 inpatients admitted to the Lacor Hospital (Gulu, Uganda) during the period 1992-1997 was performed. Children less than five years old represented 46.5% of the admissions, and the burden of infectious diseases on pediatric admissions increased over time, especially due to malaria and measles. Infectious diseases accounted for 7 of the 10 leading causes of admission. The most frequent cause was malaria (21.8% of total). The second leading infectious disease resulting in admission was respiratory tuberculosis (6.2%); given the long hospital stay, this is the most important disease in terms of hospital bed days (24.6%). Infectious diseases have represented a progressively heavy burden on hospital services, mostly due to pediatric admissions. Respiratory tuberculosis and malaria represent nearly one-third of the overall burden in terms of hospital bed days.

Adolescent↗

PubMed1990

Identification of adverse events occurring during hospitalization. A cross-sectional study of litigation, quality assurance, and medical records at two teaching hospitals.

STUDY OBJECTIVES: To estimate the efficacy of a medical record review for identifying adverse events and negligent case suffered by hospitalized patients. DESIGN: Cross-sectional study comparing an objective medical record review with information available from hospital quality assurance records as well as risk management and litigation records. SETTING: Two metropolitan teaching hospitals in the northeastern United States. MEASUREMENTS AND MAIN RESULTS: Using the litigation and risk management records as a criterion standard, we found that the medical record review had a sensitivity of 80% (93 of 116; 95% CI, 73% to 88%) for discovering adverse events and a sensitivity of 76% (51 of 67; 95% CI, 66% to 86%) for discovering negligent care. We estimated that record review of a random sample of hospitalizations across a geographic region would have even higher sensitivity (adverse-event sensitivity, 84%; negligence sensitivity, 80%). Moreover, we found that the adverse events we failed to discover led to less costly malpractice claims. A significant number of adverse events (20 of 172) among hospitalizations never gave rise to litigation or risk management investigation. Six of the twenty were due to negligent care. Quality assurance efforts at the level of the clinical departments in one hospital led to review of only 12 out of 82 risk management records. CONCLUSIONS: The overwhelming majority of adverse events and episodes of negligent care are discoverable with the methods we used to evaluate medical records. Quality assurance efforts using similar record review methods should be further evaluated.

Cross-Sectional Studies↗

PubMed1995

The political correctness of a physician hospital organization may precipitate its demise in a community hospital.

Health maintenance organizations are placing an increased pressure on physicians and hospitals to assume the risk of providing health care services under capitated agreements. They believe that if the providers' profits are based upon their cost-efficient provision of medical services, they will control their use of medical resources and reduce health care spending. Managing the risks of a capitated contract necessitates the integration of the hospital's and the physician's incentives. However, is the most appropriate legal structure that will enable physicians and hospitals to form risk-sharing contracts with managed care entities and manage these contracts profitably a physician-hospital organization? It is estimated that over 50 percent of the physician-hospital organizations that are created each year fail within the first two years of their operation because of political and financial reasons. A multispecialty group composed of select physicians, who are willing to integrate their practices and who have a low length of stay in the hospital, may be in a better position to manage the risks imposed by capitated contracts.

Attitude to Health↗

PubMed1992

Court upholds hospital that fired employee who refused drug test. Kemp v. Clairborne County Hospital.

An employee at 23-bed Claiborne County Hospital, Port Gibson, MS, who sued the hospital after she was terminated for refusing to comply with the facility's drug-testing program, has lost her case, but the hospital is changing its testing methods to avoid future problems. The testing procedure was initiated because the hospital believed it had reasonable grounds to suspect that a mass drug test of its employees would turn up evidence of work-related drug or alcohol use. The test proved that a few hospital employees were using substances while working, says Melvin H. McFatter, Port Gibson, the hospital's attorney. The employees were given advance written notice of the date and place of the test. All employees gave advance written consent to the test. Blood and urine samples were drawn.

Employment↗

PubMed1998

Theft of expensive hospital medical equipment: how professional thieves have been operating in Florida; what you should be doing to protect your hospital's assets.

A number of Florida hospitals report they have fallen prey to thieves who are dressing as hospital workers or service company employees and stealing expensive medical equipment. The thefts are creating both financial loss to hospitals and the danger that some lifesaving equipment will be missing when needed. More than 50 hospitals have been hit over the past 18 months, says Jim Kendig, incoming president of the Florida Society for Healthcare Security and Safety Professionals, Orlando. Are these thefts the tip of the iceberg? Logic dictates they are taking place or will take place elsewhere, since there is nothing different security-wise or equipment-wise about Florida hospitals compared to those in the rest of the country that would limit criminals to one state. Therefore, the lessons learned by Florida hospitals, as detailed in this report, are worth heeding elsewhere.

Deception↗

PubMed1979

Government health policy and hospital labor costs: the effects of wage and price controls on hospital wage rates and employment.

This study examines the rapid growth of hospital wage rates and employment levels over the past decade, with particular attention to the period 1971-73, when wage and price controls were in effect throughout the economy. The analysis shows that the hospital regulations under the Economic Stabilization Program reduced real hospital wages below what they would have been in the absence of controls; a similar but smaller effect of the controls on hospital employment levels is also shown. This suggests that if the current HEW proposal for hospital cost containment is enacted, its impact would be a significant decrease in the rate of growth of hospital wages and employment.

Cost Control↗

PubMed1998

Implementation of a hospital information system in a Greek university hospital.

Application of an integrated Hospital Information System in Areteion University Hospital was launched 3 years ago. As it was the very first time that a fully fledged Hospital Information System was applied in complex university hospital environment, numerous problems and issues were brought up during this first period. The most critical issues are described in this paper, giving simply the essence of the problem and the general strategic line which was followed. Issues of hospital's strategic goals, behavioural aspects of the users, technical problems of the software application, as well as issues of maturity of key players and tools per se and in their interaction, were faced by the management team of Hospital Information System.

Greece↗

PubMed2000

[Hospital readmission for heart failure in a general hospital].

OBJECTIVE: Heart failure (HF) is the most common discharge diagnosis for admission and readmission in adult. Prior studies have reported that elderly patients who survive hospitalization for HF, are particularly vulnerable to readmission. The present study was realized to investigate the characteristics of patients with readmissions for HF and the features of this hospitalizations. METHODS: This observational study, looked for patients with two or more hospital admissions with diagnosis of HF in 1996 in Gregorio Marañón General Hospital (Madrid). From them, it was taken a random sample. Second and following admissions were studied (readmission). RESULTS: There were 1561 hospitalizations for HF in 1996, being 349 second or following admissions (22.4%). After analyzing 153, it was found a 75.8% of readmissions in the first 90 days after discharge. The mean age was 77.4 +/- 10.31. More than a half were women and patients have an important comorbidity (pathologies presented more frequently were Diabetes Mellitus and airways obstructive diseases). From patients with echocardiography performed before readmission, 66.4% present left ventricular systolic dysfunction and 33.6% have normal left ventricular systolic function. The principal aetiologies were coronary artery disease, valvular heart disease and hypertension (in those patients in which aetiology have been investigated). CONCLUSION: Readmission after a hospitalization for HF is common, with a high percentage of patients readmitted in a short time. This rate demands efforts to identify patients with a higher likelihood of readmission and develop programs to clarify the determinants of this problem and thus improve it.

Aged↗