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PubMed1987

Cost of implementing Veterans Administration directives for handling antineoplastic agents.

Directives issued by the Veterans Administration central office for the safe handling of antineoplastic agents are described, and the costs associated with implementing these directives are reported. The directives are similar to other recent guidelines, including those issued by the Occupational Safety and Health Administration. Inventory records for a 12-month period were analyzed to determine the total number of doses of antineoplastic agents prepared and the total number of treatments administered at a 704-bed VA facility with a comprehensive cancer treatment program. For 3112 prepared doses and 2345 treatment regimens, the total cost of implementing the directives was $57,115, including $6,670 for the purchase of a vertical laminar-airflow hood. The VA central office directives represent reasonable guidelines for controlling the potential hazards of handling antineoplastic agents. Considerable expense is associated with implementing the directives; the degree of added expense will vary based on the particular hospital setting, the number of doses of antineoplastic agents administered, and the nature of the oncology services already in place.

Antineoplastic Agents↗
PubMed1987

Changing patterns of hip fracture care before and after implementation of the prospective payment system.

We tested the hypothesis that since the implementation of the prospective payment system (PPS), elderly patients hospitalized for hip fractures receive shorter, less care-intensive hospitalizations and are more frequently institutionalized. In blinded fashion, we reviewed the charts of elderly patients with hip fractures admitted to a municipal hospital from 1981 through 1985. Demographic and clinical characteristics of patients treated before implementation of the PPS were similar to patients treated thereafter. After implementation of the PPS, the mean length of hospitalization fell from 16.6 to 10.3 days, and the mean number of physical therapy sessions received decreased from 9.7 to 4.9. Concomitantly, the proportion of patients discharged to a nursing home increased (21% to 48%), as did the proportion receiving nursing home care at six months after discharge (13% to 39%). This increase in long-term nursing home placement suggests that the quality of care for elderly patients with hip fractures may have deteriorated.

Aged↗
PubMed1985

9-1-1 implementation: implications for poison center access.

House Bill 3178, passed by the 1981 Oregon Legislature, requires state-wide participation in a 9-1-1 emergency telephone system by 1991. It further requires deletion of all emergency telephone numbers other than 9-1-1 from the front cover of all telephone directories. The gradual implementation of 9-1-1 provided a unique opportunity to study telephone access to the poison center. The impact of 9-1-1 implementation was assessed, in a two-month survey of calls from the general public, to determine awareness of 9-1-1 availability and the source used to gain access to the poison center. Results showed that most callers (72%) had access to and were aware of 9-1-1. Callers obtained the poison center number from the telephone directories (28%), health care providers (19%), poison symbols supplied by the poison center (15%), directory assistance (9%), or other sources. Only 3% of the callers were referred from 9-1-1. State-wide implementation of 9-1-1 will have a major impact on the public's access to the poison center. The results of this study will be used to develop strategies for cooperation with 9-1-1 agencies.

Information Services↗
PubMed1983

Implementation of the Integrated Library System: University of Maryland Health Sciences Library.

The Health Sciences Library, University of Maryland, has implemented the Integrated Library System (ILS), a minicomputer-based library automation system developed by the Lister Hill National Center for Biomedical Communications, National Library of Medicine. The process of moving a library from a manual to a computerized system required comprehensive planning and strong commitment by the staff. Implementation activities included hardware and software modification, conversion of manual files, staff training, and system publicity. ILS implementation resulted in major changes in procedures in the circulation, reference, and cataloging departments.

Computers↗
PubMed1982

Preparing to implement.

The steps involved in preparing to implement a pharmacy computer system are described. Although the order in which the various steps have to be completed varies according to the hospital specifics, important elements of the preparation process include preparation of the site, organization of personnel, development of policies and procedures, developing and ordering forms, preparation of the implementation schedule, file development, and preparation of other departments. A well-designed plan and a realistic time schedule for the preparation process facilitates the actual implementation of a pharmacy computer system.

Computers↗
PubMed1995

Implementing corporate wellness programs: a business approach to program planning.

1. Support of key decision makers is critical to the successful implementation of a corporate wellness program. Therefore, the program implementation plan must be communicated in a format and language readily understood by business people. 2. A business approach to corporate wellness program planning provides a standardized way to communicate the implementation plan. 3. A business approach incorporates the program planning components in a format that ranges from general to specific. This approach allows for flexibility and responsiveness to changes in program planning. 4. Components of the business approach are the executive summary, purpose, background, ground rules, approach, requirements, scope of work, schedule, and financials.

Commerce↗
PubMed1995

Understanding and implementing hospital information systems.

One of a hospital's greatest resources is its information. The hospital's information system, whether computerized or manual, is the means by which data is collected, integrated, and retrieved. However, because optimal patient treatment, financial management, and hospital operation require that decisions be based on current, accurate, complete, and well-organized data, a computerized hospital information system (HIS), when correctly implemented, can be the most effective means of disseminating valuable information to decision makers. Although the systems currently in place in most hospitals are used primarily to manage finances, an integrated HIS is much more than a financial system; it can, in fact, coordinate all of a hospital's information needs. An integrated HIS develops over time, typically several years. Merely automating existing procedures may not provide many of the potential benefits of a new system and may even carry forward most of the drawbacks of the old system. Determining how information is currently processed in the hospital and putting together an effective team to carry out acquisition and implementation of an HIS must precede the purchase of computers, networks, and software applications. In Part 1 of this article, we describe hospitals' general information needs and provide an overview of the current state of HISs and what hospitals can expect to gain from implementing a new system; in Part 2, we describe the steps hospitals can take when putting the system in place. We caution readers that, although we will be discussing many benefits of successful HISs, little documented or quantified evidence exists to show that these benefits are being realized; most evidence is subjective and qualitative, and claims are not thoroughly substantiated. Few, if any, hospitals have achieved the completely integrated system model--or even come close. Nevertheless, this article provides the groundwork for hospitals to make a thoughtful beginning. In upcoming issues, we will be publishing further articles in our information systems series. Also see our extensive Guidance Article on Laboratory Information Systems in Health Devices 23(10-11), October-November 1994. ECRI will also be increasing the number of reports on information systems in its Healthcare Product Comparison System.

Capital Expenditures↗
PubMedDate not supplied

The cost of treating pressure ulcers following implementation of a research-based skin care protocol in a long-term care facility.

Although concern for the costs associated with pressure ulcer treatments persists, studies that precisely quantify costs are limited. A retrospective research design was used to describe the costs incurred by an 830-bed, long-term care facility to treat 81 pressure ulcers over a one-year period following implementation of a research-based, skin care protocol. The total cost for the study period was $30,079 with 73% of these expenditures attributable to nursing care. Mean cost of treatment was $3.74/pressure ulcer/day, which was a reduction from the $5.35/pressure ulcer/day cost prior to implementation of the skin care protocol. These findings suggest that implementing a research-based, skin care protocol can promote a reduction in treatment costs.

Adult↗
PubMed1995

Implementation and evaluation of a computer-based preventive services system.

BACKGROUND AND OBJECTIVES: Insufficient attention has been paid to the role that modern information systems can play in improving the delivery of and education about preventive services in family medicine training and practice sites. From September 1990-September 1993, the Department of Family Medicine at the Medical University of South Carolina conducted a demonstration project designed to develop, implement, and evaluate a comprehensive, computer-based preventive services delivery and educational system, based on the recommendations in the US Preventive Services Task Force (USPSTF) Report. METHODS: A computer-based patient record (CPR) system was implemented. The system had sophisticated preventive services tracking and reminder, physician, and patient education features. Twenty-nine basic USPSTF recommendations were incorporated in the system. An extensive physician education series was also implemented. A multi-method evaluation system, including patient exit surveys, physician interviews, and practice audits was used to evaluate and design improvements to the CPR and education systems. RESULTS: Although the system initially had no effect on patient perceptions about the frequency of preventive services delivery, there was reasonable concordance between patient desires and physician behavior for the discussion of preventive services (Kappa = .5 to .6). Physician acceptance of the system was good--in 1992, 30% of physicians used the preventive services reminders in most of their patient visits, and in 1993, 88% of physicians reported more frequent use. Practice audits from February 1992-July 1993 showed increased adherence with all seven counseling services, 10 of 15 screening services, and one of five immunization services. CONCLUSIONS: A CPR-based preventive services system coupled with an adaptable physician education about and delivery of preventive services. an ideal solution to improving the education about and delivery of preventive services.

Adolescent↗
PubMed1994

[Implementation of the Declaration of St. Vincent].

The St Vincent Declaration, signed in 1989 by representatives of diabetes associations and experts in diabetology and public health, as well as representatives of European health ministers, is a programme designed to improve the quality of care provided to diabetics in Europe. In France, one of the tasks of the Conseil Supérieur du Diabète (Diabetes Council) is to ensure that this programme is widely implemented. There are multiple facts to the implementation of this project: specific information for diabetics regarding their care, campaigns aimed at the public and health professionals, the setting up of epidemiological studies, and the organization of management strategies. Diabetologists are in the front line of professionals involved in the implementation of this programme, due to their involvement in diabetic education and in the treatment of diabetes and its complications. Even more than previously, the quality of life of the patients is a key objective.

Denmark↗
PubMed1994

Implementation of the Medicare influenza vaccination benefit--United States, 1993.

Influenza is a major cause of debilitating illness and premature death in the United States, particularly among persons aged > or = 65 years and those with chronic conditions such as lung or heart disease, diabetes, and cancer. Medicare reimbursement for excess hospitalizations during influenza epidemics ranges from $750 million to $1 billion (1). In May 1993, influenza vaccination became a covered Medicare benefit after its potential cost-effectiveness was established by the Medicare Influenza Vaccine Demonstration (2). During the fall of 1993, the Health Care Financing Administration (HCFA) initiated an information campaign to promote use of the influenza vaccination benefit, implemented simplified billing procedures, and improved electronic billing capabilities. However, reports during the 1993-94 influenza season suggested problems experienced by state and local health departments in implementing the new benefit. To characterize public influenza vaccination programs and problems with implementing this benefit, in the spring of 1994, CDC collected information from all 63 state and local health departments receiving federal immunization grants. This report summarizes the reports from these programs.

Aged↗
PubMed1994

Dimensions associated with successful implementation of a hospital based integrated order entry system.

Implementation of an integrated electronic medical record requires direct physician order entry. This application involves multi-level changes in the whole system of care, from physicians attitudes to interdepartmental relations. This study reports the results of the first round of a modified Delphi, where a diverse group of individuals were asked to identify the most important facilitating and impeding factors associated with implementation of an order entry application. From a Q-sort of their responses, we identified 20 systemic, behavioral, and attitudinal dimensions perceived to be causal factors in successful implementation. We also explored how these dimensions may influence success by comparing successful with unsuccessful hospitals in terms of the frequency with which these dimensions were differently mentioned by respondents. We found that although available functionality was the most commonly mentioned factor by all participants, hardware availability, physician involvement, administration support, and medical administration involvement were more often mentioned by successful hospitals than by less successful hospitals. These results suggest that these factors were not present in the less successful hospitals. We also found that the frequency of responses within each category varied depending on the institutional role of the individuals responding. Those involved in support tended to see organizational variables as more important than those in clinical positions, whereas clinicians viewed administrative support and involvement of the chief as more important. These findings support the notion that the changes involved in instituting a physician order entry system are system wide and involve individual as well as organizational factors.

Attitude of Health Personnel↗
PubMed1994

Towards effective implementation of a pediatric asthma guideline: integration of decision support and clinical workflow support.

Successful local implementation of national guideline recommendations requires attention to factors that promote clinician compliance. Design of a computerized system is described that will implement recommendations from a recently published guideline for outpatient management of childhood asthma exacerbations. Logical analysis of the guideline shows that it is incomplete and contains several ambiguities that must be addressed before the guideline can be operationalized. Once the user-audience is defined guideline decision points are examined and a structured data entry system is devised. Support of clinicians' workflow is provided by an integrated capability for encounter documentation, dosage calculation, and prescription-writing. A pen-based, graphical interface represents an appropriate platform for implementation of the system because of its ease of use and portability.

Asthma↗
PubMed1994

Development of a nursing research utilization program in a clinical oncology setting: organization, implementation, and evaluation.

PURPOSE/OBJECTIVES: To describe a research utilization program in the nursing department of a National Cancer Institute-designated comprehensive cancer center, including prerequisites for its development, its relationship to the department's nursing research program, the research utilization model used in the program, and evolution, evaluation, and future directions of the program. DATA SOURCES: Computerized literature searches; published articles, abstracts, and books; personal communications; departmental, committee, and task force meetings; nursing grand rounds; workshops; and inhouse surveys of nursing staff. DATA SYNTHESIS: Review and use of available information led to a comprehensive, multicomponent, departmental research utilization program that addressed issues raised in both the literature and in clinical practice. CONCLUSIONS: The nursing department was able to implement a research utilization program under the aegis of its research program that was consistent with the department's philosophy, goals, and organizational structure. Although many challenges and issues arose, ongoing evaluation measures indicate wide acceptance, successful implementation and direct influence on practice. IMPLICATIONS FOR NURSING PRACTICE: With strong administrative support, a departmental nursing research utilization program that enables participation of nursing staff and results in research-based practice and professional development can be implemented.

Baltimore↗
PubMed1994

Implementation of the Ottawa ankle rules.

OBJECTIVE: To assess the impact on clinical practice of implementing the Ottawa ankle rules. DESIGN: Nonrandomized, controlled trial with before-after and concurrent controls. SETTING: Emergency departments of a university (intervention) hospital and a community (control) hospital. PATIENTS: All 2342 adults seen with acute ankle injuries during 5-month periods before and after the intervention. INTERVENTION: The implementation of the Ottawa ankle rules by emergency department physicians. MAIN OUTCOME MEASURE: Proportions of patients referred for standard ankle and foot radiographic series. RESULTS: There was a relative reduction in ankle radiography by 28% at the intervention hospital but an increase by 2% at the control hospital (P < .001). Foot radiography was reduced by 14% at the intervention hospital but increased by 13% at the control hospital (P < .05). Compared with nonfracture patients who had radiography during the after period at the intervention hospital, those discharged without radiography spent less time in the emergency department (80 minutes vs 116 minutes; P < .0001), had lower estimated total medical costs for physician visits and radiography ($62 vs $173; P < .001), but did not differ in the proportion satisfied with emergency physician care (95% vs 96%) or undergoing subsequent radiography (5% vs 5%). The rules were found to have sensitivities of 1.0 (95% confidence interval [CI], 0.95 to 1.0) for detecting 74 malleolar fractures and 1.0 (95% CI, 0.82 to 1.0) for detecting 19 midfoot fractures. In the following 12 months at the intervention hospital, use of radiography did not increase. CONCLUSIONS: Implementation of the Ottawa ankle rules led to a decrease in use of ankle radiography, waiting times, and costs without patient dissatisfaction or missed fractures. Future studies should address the generalizability of these decision rules in a variety of hospital settings.

Adult↗
PubMed1993

A study of the implementation of the policy to refer children from the community dental service to the general dental service.

The aim of this study was to investigate the process of implementing the transfer of child patients from the community dental services to the general dental services, for dental care. A postal questionnaire investigated the current activities of district dental officers regarding the implementation of the transfer. Utilising data from the questionnaires, a series of interviews was set up with the following individuals in three districts: district dental officers, two community dental officers, the general manager of the family health services authority, the chairman of the local dental committee, and a general dental practitioner. The majority of respondent districts (65.3 per cent) reported procedures in place for the referral of children from the community dental services to the general dental services. Examination of the interview data revealed that the extent to which individual community dental officers implemented the referral process showed individual variation.

Child↗
PubMed1994

Changes in antipsychotic drug use in nursing homes during implementation of the OBRA-87 regulations.

OBJECTIVES: To describe the changes in antipsychotic drug use in nursing homes during the period surrounding the implementation of federal legislation designed to reduce unnecessary use (the Omnibus Budget Reconciliation Act of 1987 [OBRA-87]) and to identify nursing home characteristics associated with such changes. DESIGN: Longitudinal study of 9432 Tennessee Medicaid enrollees 65 years of age or older who continuously resided in Tennessee from April 1, 1989, to September 30, 1991, a 30-month period surrounding implementation of OBRA-87. MAIN OUTCOME MEASURES: Changes in the use of antipsychotic and other psychotropic drugs. RESULTS: During the 30-month period, antipsychotic drug use decreased from 23.9 to 17.5 days per 100 days of residence, a 26.7% decline (P < .001), which resulted from both a decrease in new users (P < .001) and a reduction in long-term use of antipsychotic drugs (P < .001). There was no concomitant increase in other psychotropic drug use. A multivariate analysis revealed that changes in antipsychotic use were strongly associated with baseline antipsychotic use (P = .001) and third-shift staffing levels (P = .003). Nursing homes with baseline antipsychotic drug use and third-shift staffing above the median reduced antipsychotic drug use by 41%, compared with a 2% increase in nursing homes where both of these factors were below the median (P < .0001). CONCLUSIONS: A substantial decrease in antipsychotic drug use coincided with the implementation of OBRA-87. Although this decrease is consistent with an improvement in quality of nursing home care, further research is needed to determine the effects of this legislation on resident outcomes.

Aged↗