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Hospital System (hospital + system)
Selected AbstractsThe medical emergency team: does it really make a difference?INTERNAL MEDICINE JOURNAL, Issue 11 2003M. Cretikos Abstract Hospital systems are failing the critically ill. This has been well documented in many countries around the world, with detailed reports of suboptimal care prior to intensive care and high rates of serious adverse events, including death. These events are potentially preventable, but insufficient attention has been directed towards developing solutions to these important problems to date. The medical emergency team (MET) is a system approach that promotes early and appropriate intervention in the care of critically ill hospital patients. The benefits of the MET in terms of absolute in-patient mortality and cardiac arrest rates are not yet well-defined, although preliminary studies are promising. The MET does provide a potentially beneficial impact on many other aspects of patient care. These benefits include: (i) facilitating an integrated and coordinated approach to patient care across the hospital, (ii) increasing awareness of at-risk patients, (iii) encouraging early referral of seriously ill patients to clinicians with expertise in critical care and (iv) providing a foundation for quality initiatives for hospital-wide care of the seriously ill. The MET also empowers nursing staff and junior medical staff to call for immediate assistance in cases where they are seriously concerned about a patient, but may not have the experience, knowledge, confidence or skills necessary to manage them appropriately. (Intern Med J 2003; 33: 511,514) [source] A pre-employment programme for overseas-trained doctors entering the Australian workforce, 1997,99MEDICAL EDUCATION, Issue 7 2002Elizabeth A Sullivan Objectives Overseas-trained doctors (OTDs) have limited access and formal interaction with the Australian health care system prior to joining the Australian medical workforce. A pre-employment programme was designed to familiarize OTDs with the Australian health care system. Method All OTDs who had passed their Australian Medical Council (AMC) exams and were applying for a pre-registration year in New South Wales were invited to participate in the voluntary, free programme. A 4-week full-time programme was developed consisting of core group teaching and a hospital attachment. The curriculum included communication, health and workplace skills; and sessions on culture shock and the role of junior doctors. A pilot programme was run in 1997. The programme was repeated in 1998 and 1999. The OTDs' confidence regarding the general duties of internship, and attitudes towards hospital workplace skills were examined. Results The 66 OTDs reported greater understanding of staff and communication issues and familiarization with the hospital environment. They reported a more realistic understanding of the role of a junior doctor, the need for separation of workplace and personal responsibilities and knowledge of pathways for future professional development. The course structure, with a focus on hospital attachments, establishment of a peer network, and workplace familiarization facilitated entry into the hospital workforce. Conclusion The pre-employment programme enabled the OTDs to have a more equitable entry into the public hospital system, resulting in a more integrated, confident and functional workforce. [source] The place of premedication in pediatric practicePEDIATRIC ANESTHESIA, Issue 9 2009ABRAHAM ROSENBAUM MD Summary Behind the multiple arguments for and against the use of premedication, sedative drugs in children is a noble principle that of minimizing psychological trauma related to anesthesia and surgery. However, several confounding factors make it very difficult to reach didactic evidence-based conclusions. One of the key confounding issues is that the nature of expectations and responses for both parent and child vary greatly in different environments around the world. Studies applicable to one culture and to one hospital system (albeit multicultural) may not apply elsewhere. Moreover, the study of hospital-related distress begins at the start of the patient's journey and ends long after hospital discharge; it cannot be focused completely on just the moment of anesthetic induction. Taking an example from actual practice experience, the trauma caused by the actual giving of a premedication to a child who absolutely does not want it and may struggle may not be recorded in a study but could form a significant component of overall effect and later psychological pathology. Clearly, attitudes by health professionals and parents to the practice of routine pediatric premedication, vary considerably, often provoking strong opinions. In this pro,con article we highlight two very different approaches to premedication. It is hoped that this helps the reader to critically re-evaluate a practice, which was universal historically and now in many centers is more selective. [source] The acute,aged care interface: Exploring the dynamics of ,bed blocking'AUSTRALASIAN JOURNAL ON AGEING, Issue 3 2008Catherine M Travers Objective: To understand the dynamics underlying ,bed-blocking' in Australian public hospitals that is frequently blamed on older patients. Methods: Analysis of primary and secondary data of utilisation patterns of hospital and aged care services by older Australians. Results: A model of the dynamics at the acute,aged care interface was developed, in which the pathway into permanent high-care Residential Aged Care (RAC) is conceptualised as competing queues for available places by applicants from the hospital, the community and from within RAC facilities. The hospital effectively becomes a safety net to accommodate people with high-care needs who cannot be admitted into RAC in a timely manner. Conclusion: The model provides a useful tool to explore some of the issues that give rise to access-block within the public hospital system. Access-block cannot be understood by viewing the hospital system in isolation from other sectors that support the health and well-being of older Australians. [source] CONGESTIVE CARDIAC FAILURE: URBAN AND RURAL PERSPECTIVES IN VICTORIAAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 6 2003Mohammad Z. Ansari ABSTRACT Objective:,Effective and timely care for congestive cardiac failure (CCF) should reduce the risks of hospitalisation. The purpose of this study is to describe variations in rates of hospital admissions for CCF in Victoria as an indicator of the adequacy of primary care services. Detailed analyses identify trends in hospitalisations, urban/rural differentials and variations by the Primary Care Partnerships (PCP). Setting:,Acute care hospitals in Victoria. Design:,Routine analyses of age and sex standardised admission rates of CCF in Victoria using the Victorian Admitted Episodes Dataset from 1993,1994 to 2000,2001. Subjects:,All patients admitted to acute care hospitals in Victoria with the principal diagnosis of CCF between 1993,1994 and 2000,2001. Results:,There were 8359 admissions for CCF in Victoria with an average of 7.37 bed days in 2000,2001. There was a significantly higher admission rate for CCF in rural areas compared to metropolitan in 2000/2001 ,(2.53/1000 (2.44,2.62) and 1.80/1000 (1.75,1.85)) , respectively. Small area analyses identified 17 PCP (14 of which were rural) with significantly higher admission rate ratios of CCF compared to Victoria. Conclusion:,Small area analyses of CCF have identified significant gaps in the management of CCF in the community. This may be a reflection of deficit in primary care availability, accessibility, or appropriateness. Detailed studies may be needed to determine the relative importance of these factors in Victoria for targeting specific interventions at the PCP level. What does this study add?:,Congestive cardiac failure is a major public health problem. In Australia, there is a lack of studies identifying long-term hospitalisation trends of CCF, as well as small area analyses, especially in regard to rural and urban variations. This study has identified significant variations over an eight year period in admission rates of CCF in rural and urban Victoria. Small area analyses (e.g. at the level of primary care partnerships) have identified rural communities with significantly higher admission rates of CCF compared to the Victorian average. For the first time in Australia, this study has provided a new approach for generating evidence on quality of primary care services in rural and urban areas, and offers opportunities for targeting public health and health services interventions that can decrease access barriers, improve the adequacy of primary care, and reduce demand on the hospital system in Victoria. [source] Pediatric hospital medicine core competencies: Development and methodologyJOURNAL OF HOSPITAL MEDICINE, Issue S2 2010Erin R. Stucky MD Abstract Background: Pediatric hospital medicine is the most rapidly growing site-based pediatric specialty. There are over 2500 unique members in the three core societies in which pediatric hospitalists are members: the American Academy of Pediatrics (AAP), the Academic Pediatric Association (APA) and the Society of Hospital Medicine (SHM). Pediatric hospitalists are fulfilling both clinical and system improvement roles within varied hospital systems. Defined expectations and competencies for pediatric hospitalists are needed. Methods: In 2005, SHM's Pediatric Core Curriculum Task Force initiated the project and formed the editorial board. Over the subsequent four years, multiple pediatric hospitalists belonging to the AAP, APA, or SHM contributed to the content of and guided the development of the project. Editors and collaborators created a framework for identifying appropriate competency content areas. Content experts from both within and outside of pediatric hospital medicine participated as contributors. A number of selected national organizations and societies provided valuable feedback on chapters. The final product was validated by formal review from the AAP, APA, and SHM. Results: The Pediatric Hospital Medicine Core Competencies were created. They include 54 chapters divided into four sections: Common Clinical Diagnoses and Conditions, Core Skills, Specialized Clinical Services, and Healthcare Systems: Supporting and Advancing Child Health. Each chapter can be used independently of the others. Chapters follow the knowledge, skills, and attitudes educational curriculum format, and have an additional section on systems organization and improvement to reflect the pediatric hospitalist's responsibility to advance systems of care. Conclusion: These competencies provide a foundation for the creation of pediatric hospital medicine curricula and serve to standardize and improve inpatient training practices. Journal of Hospital Medicine 2010;5(4)(Suppl 2):82,86. © 2010 Society of Hospital Medicine. [source] | ||||||||||