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Professional shopping of hospital services: an analysis of sub rosa investigative methods in determination of quality.

Using professional shopping, or sub rosa investigative methods, an actor was admitted to a hospital with a diagnosis of rule out myocardial infarction to ascertain quality data. An interesting finding was the interrelatedness of quality throughout the organization. The sub rosa investigator described many intraorganizational quality problems, including how the actions of one department affected quality in another. To evaluate the enormous amount of information provided by the investigator, the data were segregated by events that could be evaluated for quality. Only one event led to the conclusion that a new source of quality information was attributable to the sub rose investigator's findings. Hospitals using sub rosa investigative techniques may obtain large amounts of quality information in a relatively short period.

Hospitals, Proprietary

Shopping around for hospital services: a comparison of the United States and Canada.

CONTEXT: Historical comparisons indicate that US hospitals are more expensive than Canadian hospitals, but health care system reform might have changed the relative costs and timeliness of health care in the 2 countries. OBJECTIVE: To estimate the price and convenience of selected hospital services in the United States and Canada for patients in 1997 had they paid out-of-pocket. DESIGN: Cross-sectional telephone survey conducted May 1996 to April 1997. PARTICIPANTS: The 2 largest acute care general hospitals from every city in the United States and Canada with a population greater than 500000. MEASURES: Each hospital was telephoned and asked their price and waiting time for 7 services: magnetic resonance imaging of the head without gadolinium; a screening mammogram; a 12-lead electrocardiogram; a prothrombin time measurement; a session of hemodialysis; a screening colonoscopy; and a total knee replacement. Waiting times were measured in days until earliest appointment and charges were converted to American currency. RESULTS: Overall, 48 US and 18 Canadian hospitals were surveyed. Median waiting times were significantly shorter in American hospitals for 4 services, particularly a magnetic resonance imaging of the head (3 days vs 150 days; P<.001). Median charges were significantly higher in American hospitals for 6 services, particularly for a total knee replacement ($26805 vs $10651; P<.001). Individual services showed no association between shorter waiting times and higher prices within each country, with the exception of a total knee replacement in the United States. CONCLUSION: US hospitals still provide higher prices and faster care than Canadian hospitals for patients who pay out-of-pocket.

Canada

Possible nosocomial transmission of psittacosis.

OBJECTIVES: To investigate a cluster of seven pneumonia cases among persons exposed to a pet-shop worker hospitalized with psittacosis. DESIGN: Epidemiological study of the outbreak, sero-diagnostic evaluation of exposed persons with pneumonia; and retrospective review of the pneumonia cases. SETTING: 450-bed teaching community hospital. PARTICIPANTS: Employees of the nursing unit where the patient with psittacosis was hospitalized. RESULTS: The index case had laboratory and clinical evidence of psittacosis. Four of the seven exposed persons who developed pneumonia had serologic results that met criteria for a diagnosis of psittacosis, and three met criteria for Chlamydia pneumoniae infection, possibly reflecting cross-reactivity between the microimmunofluorescence assays for the two diseases. The epidemiological graph suggested a relationship between the index case and the cluster of pneumonias in exposed individuals. CONCLUSIONS: Psittacosis may have been transmitted person to person in a hospital setting.

Chlamydophila psittaci

Sensitization to epoxy resin systems in special flooring workers.

The use of new products in building and public works is increasing, among them being special floor coverings containing epoxy resins and derivatives. These are used principally in heavily frequented areas, such as shopping precincts, hospitals, civic centres, etc., due to their high resistance to wear and tear, environmental factors, etc. In the last 2 years, we have studied 15 cases of men sensitized to epoxy resin, or derivatives, who worked with special floorings. Speed of sensitization, severity of lesions, and localization to the hands, face and legs were characteristic.

Adult

Death by bolus impaction of the larynx.

The paper reports on 78 cases of fatal choking observed in the Institute of Legal Medicine, University of Duesseldorf, since 1947. The age median of all victims was 53 years. There were 24 females among the victims. Only in one child a solitary occlusion of the glottis by a collar-button was found. In all other cases bolus material was distributed over more than one region, e.g. larynx, glottis and trachea. In 50 victims single pieces of meat, ham, herring etc. were found. In the remaining 28 cases the bolus material was roughly chewed. More than 80 per cent of cases occurred in restaurants and lodgings, only small numbers in public places, shops and hospitals. With the exception of three children, one patient with a partial horizontal resection of the larynx and some mentally handicapped persons all bolus death victims were heavily drunk (median BAC 2.1 Promille). The possible pathomechanisms were discussed.

Age Factors