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Medical Unit (medical + unit)
Selected AbstractsChildhood deaths due to electrocution in Adana, TurkeyACTA PAEDIATRICA, Issue 3 2007R Akçan Abstract Aim: This retrospective study was conducted to determine the general features of childhood deaths due to electrocution, and draw the attention of community to these preventable deaths. Methods: The autopsy records of the Morgue of the Adana Branch of the Turkish Forensic Medicine Council were used. Thirty-seven cases of childhood (under 18) electrocution during the period 1999,2004 were analyzed. Results: Electrocution deaths comprised 0.8% of all the medico-legal autopsy cases (4515) during these 6 years. Thirty-one (83.8%) of the victims were male and only six (16.2%) were female. They were between 18 months and 18 years of age, and the mean age was 11.35, and all deaths were recorded as accidental. Conclusion: Medical units, and paramedical and educational centres should play important roles in formulating public health strategies to tackle preventable deaths such as electrocution. [source] Hospital Economics of the HospitalistHEALTH SERVICES RESEARCH, Issue 3 2003Douglas Gregory Objective To determine the economic impact on the hospital of a hospitalist program and to develop insights into the relative economic importance of variables such as reductions in mean length of stay and cost, improvements in throughput (patients discharged per unit time), payer methods of reimbursement, and the cost of the hospitalist program. Data Sources The primary data source was Tufts-New England Medical Center in Boston. Patient demographics, utilization, cost, and revenue data were obtained from the hospital's cost accounting system and medical records. Study Design The hospitalist admitted and managed all patients during a six-week period on the general medical unit of Tufts-New England Medical Center. Reimbursement, cost, length of stay, and throughput outcomes during this period were contrasted with patients admitted to the unit in the same period in the prior year, in the preceding period, and in the following period. Principal Findings The hospitalist group compared with the control group demonstrated: length of stay reduced to 2.19 days from 3.45 days (p<.001); total hospital costs per admission reduced to $1,775 from $2,332 (p<.001); costs per day increased to $811 from $679 (p<.001); no differences for readmission within 30 days of discharge to extended care facilities. The hospital's expected incremental profitability with the hospitalist was,$1.44 per admission excluding incremental throughput effects, and it was most sensitive to changes in the ratio of per diem to case rate reimbursement. Incremental throughput with the hospitalist was estimated at 266 patients annually with an associated incremental profitability of $1.3 million. Conclusion Hospital interventions designed to reduce length of stay, such as the hospitalist, should be evaluated in terms of cost, throughput, and reimbursement effects. Excluding throughput effects, the hospitalist program was not economically viable due to the influence of per diem reimbursement. Throughput improvements occasioned by the hospitalist program with high baseline occupancy levels are substantial and tend to favor a hospitalist program. [source] Acute liver damage in anorexia nervosaINTERNATIONAL JOURNAL OF EATING DISORDERS, Issue 1 2004Lorenza Di Pascoli Abstract We report a case of a 26-year-old White woman with a history of anorexia nervosa who developed severe liver damage and multiorgan dysfunction. At admission to our medical unit, her body mass index (BMI) was 10.8. Biochemical evaluation showed a marked increase in serum levels of aspartate aminotransferases (AST = 9,980 IU/L), alanine aminotransferase (ALT = 3,930 IU/L), amylase (1,002 IU/L), lipase (1,437 IU/L), creatine phosphokinase (CPK; 783 IU/L), and lactate dehydrogenase (LDH = 6,830 IU/L). Glomerular filtration rate was reduced (35 ml/min), reflecting dehydration and prerenal azotemia. No other cause of acute liver damage except malnutrition was evidenced. Hydration and nutritional support were the unique medical treatment. A rapid recovery occurred in few days and all laboratory data were normal at discharge after a 37-day hospitalization. © 2004 by Wiley Periodicals, Inc. Int J Eat Disord 36: 114,117, 2004. [source] Nursing-Sensitive Outcome Reliability Testing in a Tertiary Care SettingINTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 1 2005Julia G. Behrenbeck MS purpose., To describe nursing outcomes classification (NOC) that are most relevant for, specialty acute care nursing practice, and to assess the adequacy of measures. methods., Data were collected on 434 patients during the 14-month data collection period at a tertiary care center: cardiac surgery intensive care (n = 76), cardiac transplant unit (n = 153), and medical unit (n = 205). findings., Thirty-six NOC outcomes were used 10 or more times during the study. Of those, 16 had an inter-rater reliability of 75% or higher. conclusions., NOC outcomes show promise for accurately documenting the effectiveness of nursing interventions. Further study is needed to develop meaningful analysis of the documented NOC outcomes and efficiently integrate NOC into electronic documentation systems. practice implications., Increased familiarity with NOC allowed nursing staff to determine which outcomes comprise core nursing-sensitive outcomes for their clinical setting. [source] Nursing-Sensitive Outcome Implementation and Reliability Testing in a Tertiary Care SettingINTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 2003Julia G. Behrenbeck PURPOSE To describe the NOC outcomes most relevant for specialty nursing practice and in selected field sites representing the continuum of care; to assess the adequacy of measures (reliability, validity, sensitivity, specificity, practicality); and to describe the linkages among nursing diagnoses, interventions, and outcomes in clinical decision making. METHODS Data were collected on 434 patients during the 12-month data collection period at a tertiary care center: cardiac surgery intensive care (n= 76), cardiac transplant unit (n= 153), and medical unit (n= 205). Medical diagnoses of patients on the two cardiac units were related to cardiac disease. Medical diagnoses of patients on the medical unit were extremely varied (ranging from e.g., gout to pneumonia). Data were collected on 65 separate outcome labels for a total of 633 ratings. FINDINGS In the cardiac transplant ICU, data were collected on 42 outcomes: 30 had an average interrater reliability of ,85%, and 16 had an absolute agreement interrater reliability of ,85%. In the cardiac surgery ICU, data were collected on 30 outcomes: 25 had an average interrater reliabilty of ,85%, 6 had an absolute agreement interrater of ,85%. In the medical unit, data were collected on 45 outcomes: 41 had an average interrater reliability of ,85%, 14 had an absolute agreement interrater reliability of ,85%. Four outcomes have been implemented into the documentation system for all patients: Tissue Integrity: Skin and Mucous Membranes, Mobility Level, Knowledge: Disease Process, and Coping. CONCLUSIONS Overall, nursing staff were very positive about having the opportunity to participate in nursing research. Staff were able to think about the relative status of their patient and how nursing care contributes to the patient's recovery. They appreciated the opportunity to discuss this with a colleague during the interrater exercise. Increased familiarity with NOC allows staff members to determine which outcomes comprise core nursing-sensitive outcomes for their clinical setting. [source] Prospective Evaluation of a Pediatric Inpatient Early Warning Scoring SystemJOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 2 2009Karen M. Tucker PURPOSE. The present study evaluated the use of the Pediatric Early Warning Score (PEWS) for detecting clinical deterioration among hospitalized children. DESIGN/METHODS. A prospective, descriptive study design was used. The tool was used to score 2,979 patients admitted to a single medical unit of a pediatric hospital over a 12-month period. RESULTS. PEWS discriminated between children who required transfer to the pediatric intensive care unit and those who did not require transfer (area under the curve = 0.89, 95% CI = 0.84,0.94, p < .001). IMPLICATIONS. The PEWS tool was found to be a reliable and valid scoring system to identify children at risk for clinical deterioration. [source] Protocol-based care: the standardisation of decision-making?JOURNAL OF CLINICAL NURSING, Issue 10 2009Jo Rycroft-Malone Aim., To explore how protocol-based care affects clinical decision-making. Background., In the context of evidence-based practice, protocol-based care is a mechanism for facilitating the standardisation of care and streamlining decision-making through rationalising the information with which to make judgements and ultimately decisions. However, whether protocol-based care does, in the reality of practice, standardise decision-making is unknown. This paper reports on a study that explored the impact of protocol-based care on nurses' decision-making. Design., Theoretically informed by realistic evaluation and the promoting action on research implementation in health services framework, a case study design using ethnographic methods was used. Two sites were purposively sampled; a diabetic and endocrine unit and a cardiac medical unit. Methods., Within each site, data collection included observation, postobservation semi-structured interviews with staff and patients, field notes, feedback sessions and document review. Data were inductively and thematically analysed. Results., Decisions made by nurses in both sites were varied according to many different and interacting factors. While several standardised care approaches were available for use, in reality, a variety of information sources informed decision-making. The primary approach to knowledge exchange and acquisition was person-to-person; decision-making was a social activity. Rarely were standardised care approaches obviously referred to; nurses described following a mental flowchart, not necessarily linked to a particular guideline or protocol. When standardised care approaches were used, it was reported that they were used flexibly and particularised. Conclusions., While the logic of protocol-based care is algorithmic, in the reality of clinical practice, other sources of information supported nurses' decision-making process. This has significant implications for the political goal of standardisation. Relevance to clinical practice., The successful implementation and judicious use of tools such as protocols and guidelines will likely be dependant on approaches that facilitate the development of nurses' decision-making processes in parallel to paying attention to the influence of context. [source] Readmissions: a primary care examination of reasons for readmission of older people and possible readmission risk factorsJOURNAL OF CLINICAL NURSING, Issue 5 2006Dip N, Linda Dobrzanska MSc, PG Cert HCE Aim., To identify the reasons that may have contributed to the emergency readmission of older people to a medical unit, within 28 days of hospital discharge. Background., The current UK Government has initiatives in place to monitor quality and service delivery of NHS organizations. This is achieved by setting, delivering and monitoring standards, one of which is ,emergency readmission to hospital within 28 days of discharge (all ages), as a percentage of live discharges'. Design/method., A year-long study examined reasons for unplanned readmission of patients (aged 77 and over) within 28 days of hospital discharge. The population was patients, registered with North Bradford PCT General Practitioners, readmitted to one of five care of older people wards in two local acute trust NHS hospitals. Patient records were scrutinized and data related to demography, diagnosis and readmission were collected using a structured extraction tool. Data analysis was undertaken using descriptive statistics and identification of differences and correlations within the data. Results., A pilot study indicated patients readmitted from home vs. other sources and patients discharged to home vs. other sources had a significantly shorter stay on readmission. The main study showed other significant findings. Patients who lived in care were readmitted sooner than those who lived at home: those discharged home vs. other sources and agreeing to increased social service provision had longer stays on readmission. Shorter length of stay on index admission (up to 72 hours) was associated with increased likelihood of earlier readmission. Conclusions., A framework of factors was identified and could be used to target resources to meet patients' needs more flexibly. Relevance to clinical practice., It is possible that the process of targeting resources to ,at-risk' patients might enable services to be delivered in a more cost-efficient and cost-effective way. [source] Methadone-exposed newborn infants: outcome after alterations to a service for mothers and infantsCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 2 2007J. Miles Abstract Objective, To evaluate the impact of a shared care approach in clinical management with a drug liaison midwife (DLM) service for mothers and infants established in 1995,1996 in an inner city area and to address the problem of congenital abnormality and microcephaly with fetal drug exposure. Methods, Descriptive analysis of data in live births of women enrolled in a methadone maintenance programme in 1991,1994 (n = 78) and 1997,2001 (n = 98), including time spent in hospital, treatment for neonatal abstinence syndrome (NAS), admission to the neonatal medical unit (NMU) and follow-up for child health checks. Results, In 1997,2001 compared with 1991,1994, the mothers used more methadone in the last week of pregnancy (median 40.0 mg/day vs. 21.5 mg/day, P = 0.0006) and there were more preterm deliveries (36% vs. 21%, P = 0.03). The infants spent less time in hospital (median 5 days vs. 28 days, P < 0.0001), a smaller proportion had treatment for NAS (14% vs. 79%, P < 0.0001), and NMU admission was reduced (median 14 days vs. 26 days, P < 0.0003). Neonatal convulsions (P = 0.0001) and jaundice (P < 0.001) occurred less frequently, and more infants were breastfed (P = 0.001). One infant in each study group had a cleft palate and none had microcephaly. Child health checks for 18,24 months showed a favourable outcome in 1997,2001. Conclusions, We altered antenatal care and modified neonatal management, subsequently infants spent less time in hospital and NMU admissions were reduced with less NAS treatment. Congenital abnormalities and microcephaly were not common and as regular child health checks were possible, the impact of the DLM service in shared management merits further investigation, for mother,infant bonding and developmental outcome. [source] Effective assessment of use of sitters by nurses in inpatient care settingsJOURNAL OF ADVANCED NURSING, Issue 2 2008Huey-Ming Tzeng Abstract Title.,Effective assessment of use of sitters by nurses in inpatient care settings Aim., This paper is a report of the evaluation of the impact of adopting the Patient Attendant Assessment Tool (PAAT) on nurses' requests for sitters, use of restraints, and falls and fall injury rates. Background., Staffing should be the primary issue in eliminating risks of patient falls during hospital stays. Method., Data were collected in two acute adult medical units of a Michigan hospital from August 2005 to February 2007. Data from three sources were merged for analyses: (1) study units' monthly reports; (2) quarterly reports of the National Database of Nursing Quality Indicators and (3) PAAT reports collected from October 2006 to February 2007. The primary outcome variables were the use of sitters, number of restraints ordered and fall and fall injury rates. Independent t -tests and correlation analyses were used for data analyses. The data before and after adopting this tool were compared using independent t -tests. Findings., The PAAT helped improve the fill/request rates for sitters. The use of soft limb holders decreased after adoption of this tool. The results also showed that if the number of sitter requests was higher, the total number of restraints would be lower but the total fall rate would be higher. Conclusion., Hospitals should include a tool similar to the PAAT in guidelines related to provision of constant observation or use of sitters. Further investigations of the optimum combination of staffing patterns and infrastructure are needed to promote safer hospital stays. [source] Oral quinolones in hospitalized patients: an evaluation of a computerized decision support intervention,JOURNAL OF INTERNAL MEDICINE, Issue 4 2004T. Hulgan Abstract. Objective., To determine whether a computerized decision support system could increase the proportion of oral quinolone antibiotic orders placed for hospitalized patients. Design., Prospective, interrupted time-series analysis. Setting., University hospital in the south-eastern United States. Subjects., Inpatient quinolone orders placed from 1 February 2001 to 31 January 2003. Intervention., A web-based intervention was deployed as part of an existing order entry system at a university hospital on 5 February 2002. Based on an automated query of active medication and diet orders, some users ordering intravenous quinolones were presented with a suggestion to consider choosing an oral formulation. Main outcome measure., The proportion of inpatient quinolone orders placed for oral formulations before and after deployment of the intervention. Results., There were a total of 15 194 quinolone orders during the study period, of which 8962 (59%) were for oral forms. Orders for oral quinolones increased from 4202 (56%) before the intervention to 4760 (62%) after, without a change in total orders. In the time-series analysis, there was an overall 5.6% increase (95% CI 2.8,8.4%; P < 0.001) in weekly oral quinolone orders due to the intervention, with the greatest effect on nonintensive care medical units. Conclusions., A web-based intervention was able to increase oral quinolone orders in hospitalized patients. This is one of the first studies to demonstrate a significant effect of a computerized intervention on dosing route within an antibiotic class. This model could be applied to other antibiotics or other drug classes with good oral bioavailability. [source] | ||||||||||