Leak of abortion information creates turmoil at Foothills.
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Between 1966 and 1985, 15 cases of complete rupture of the uterus in pregnancy were identified among 52,854 deliveries at Foothills Provincial General Hospital, Calgary, for an incidence rate of 0.3 per 1000 deliveries. Previous cesarean section (in seven patients) was not the only predisposing factor: a history of dilatation and curettage (in two patients) or laparoscopy (in one) were also implicated. Long, obstructed labour did not appear to be a factor. Rupture also occurred in patients at low risk. The most frequent immediate complication was hypotension, in five patients. The rupture site was repaired in 11 of the patients; the other 4 underwent hysterectomy. Close surveillance and prompt intervention are the keys to good fetal and maternal outcome.
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This article describes a system of Scheduled Days Off (SDO) that was implemented on a trial basis for one year by the Physiotherapy Section of Foothills Provincial General Hospital in Calgary, Alberta. Development of the SDO system was an attempt by the Physiotherapy Section to improve the quality of working life without a negative impact on productivity or quality of care. Each full-time physiotherapist extended work hours by 15 minutes per day and received an SDO following 30 working days. A productivity analysis of weighted units per paid hour and patient attendances per paid hour demonstrated an increase in productivity following implementation of the system. Work time used for personal appointments, sick time and staff satisfaction were evaluated and showed positive changes during the trial period.
A 4-week, province-wide nurses' strike in Alberta in 1982 caused the closure of 57% of the acute care beds, including 47% of the intensive care beds, in Calgary. The effects of the strike on patient care at Foothills Provincial General Hospital, where nurses did not strike, were assessed. The number of emergency admissions, severity of illness and rate of death in the intensive care unit increased. On the other hand, the rate of death, length of stay and number of unexpected deaths on the medical wards were similar to those in the control periods before and after the strike. A subjective perception by hospital personnel of deteriorating patient care caused much anxiety; however, the results of analysis of measurable aspects of care suggested that the patients admitted to hospital received care during the strike that was comparable to care given before or after the strike. The inconvenience and potential harm to the patients not admitted because they had less severe illness were not measured.
Information on ethyl alcohol intoxication in children is scarce. A retrospective study was conducted by chart reviews of 27 patients with documented ethanol ingestion admitted to the Alberta Children's Hospital, Foothills Provincial Hospital, Calgary General Hospital or Holy Cross Hospital from 1969 to 1984. Six patients had hypoglycemia and one experienced a convulsion. The rate of alcohol elimination was found to be greater than 6.2 mM/L/hr (28.4 mg/dl/hr), approximately twice the rate seen in adults. Six patients had hypokalemia, and two had severe metabolic acidosis.
This paper describes computer-assisted instruction designed for medical students on their clinical surgery rotation. Patient care systems continue to evolve; incentives for physician participation should include educational benefits and clinical practice guidelines. Sometimes overlooked in the rush to develop expert systems are medical students, who do not have the depth of knowledge inherent in decision support. Foothills Hospital in Calgary, Canada, uses the TDS HC4000 patient care system, where physicians and medical students enter their orders directly on the terminals. The Surgical Patient Care Program was developed to help students learn the basics of peri-operative patient management. The Program runs on the HC4000 and consists of a collection of order sets with appended educational information to guide students in their automated order selection. Unlike other instructional programs, which use fictitious patients, students enter real orders on real patients. Tracking of usage indicates that the Program is popular with students, who each access it an average of 20 times per week. An ongoing study will determine any educational benefit by measuring student performance at Foothills Hospital against a control group at another hospital, which does not have a computerized patient care system.
As emphasis on early hospital discharge increases, home tube feeding is becoming a popular method of efficiently delivering nutritional support. This paper describes the team approach to home enteral feeding practices at the Foothills Hospital in Calgary, Alberta. Three groups of patients are referred to the program: those who require tube feedings permanently as the sole means of nutrition; those who require supplementation from tube feedings; and those who temporarily require tube feeding. The dietitian selects an enteral formula suitble for the patient. Although continuous enteral feedings are generally better tolerated by patients, intermittent feedings may be more psychologically acceptable. Continuous feedings are initiated at 50 ml per hour and increased to approximately 150 ml per hour, depending upon patient tolerance and nutritional goals. Complications can result from mechanical problems (e.g. equipment failure) and metabolic/physiologic problems (e.g. constipation). A total of 35 patients have been taught the technique of home tube feeding. The program has been well accepted by patients and physicians.