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Smaller Hospitals (smaller + hospital)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

The learning environment of paediatric trainees in New Zealand

JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 9 2009
Ralph Pinnock
Aims: To assess the learning environment of New Zealand paediatric trainees, examine the factors influencing the trainee's perceptions of their learning environment and to assess the suitability of using the Postgraduate Hospital Education Environment Measure (PHEEM) in New Zealand. Methods: Paediatric trainees completed the PHEEM questionnaire and returned this anonymously by email. Results: Both basic and advanced trainees' perceptions of the environment were generally positive but significant concerns were identified. There were differences in perceptions of the learning environment between the basic and advanced trainees and between sites with more than six trainees compared with those with six or fewer trainees. The PHEEM is practical to use, showed good internal consistency and was acceptable to trainees. Conclusions: Both basic and advanced trainees perceived the learning environment positively but significant concerns must be addressed. The advanced trainees perceived the overall learning environment and the teaching they receive more positively than basic trainees. Trainees at smaller hospitals perceived that their social supports were better than at larger hospitals. The PHEEM can be used to assess the paediatric training environment in New Zealand. [source]

Modeling the Emergency Ambulance Pass-By of Small Rural Hospitals in Victoria, Australia

THE JOURNAL OF RURAL HEALTH, Issue 4 2005
Patrick Gleeson MBA
ABSTRACT: Context: Many small rural hospitals struggle to attract sufficient numbers of suitable patients. Inadequate patient throughput threatens the viability of these hospitals and, consequently, the financial, physical, and social well-being of the whole community. Anecdotal evidence suggests that many emergency ambulance patients are routinely taken past their local small rural hospital to the area's major receiving hospital. Purpose: To quantify the ambulance pass-by of local small rural hospitals and identify the factors that influence its occurrence. Methods: Data were collected from the ambulance and hospital records of 3 small rural centers in central Victoria, Australia. Results: Ambulances transport a significant number of patients past their local small rural hospitals to the area's major receiving hospital. This takes less time for paramedics than bringing a patient to the local hospital first if the patient is then redirected by that hospital to the larger hospital. There is an inverse relationship between the rate of cases in which the local hospital redirects ambulances to the regional hospital and the rate of ambulance crew decisions to use the local hospital. Conclusions: If some patients are being transported directly to the major receiving hospital because paramedics are considering their own time commitments when making patient transport decisions, this could have revenue implications for rural hospitals. Attracting appropriate local ambulance patients to the smaller hospitals may provide an income source that is currently lost to the crowded major receiving hospital's emergency department. [source]

Burnout in Australasian Younger Fellows

ANZ JOURNAL OF SURGERY, Issue 9 2009
Sarah Benson
Abstract Background:, Burnout is the state of prolonged physical, emotional and psychological exhaustion characteristic of individuals working in human service occupations. This study examines the prevalence of burnout among Younger Fellows of the Royal Australasian College of Surgeons and its relationship to demographic variables. Methods:, In March 2008, a survey was sent via email to 1287 Younger Fellows. This included demographic questions, a measure of burnout (Copenhagen Burnout Inventory), and an estimate of social desirability (Marlowe,Crowne Social Desirability Scale , Form C). Results:, Females exhibited higher levels of personal burnout (P < 0.001) and work-related burnout (P < 0.025), but no significant difference in patient-related burnout. Younger Fellows in hospitals with less than 50 beds reported significantly higher patient-related burnout levels (mean burnout 37.0 versus 22.1 in the rest, P= 0.004). An equal work division between public and private practice resulted in higher work-related burnout than concentration of work in one sector (P < 0.05). Younger Fellows working more than 60 hours per week reported significantly higher personal burnout than those who worked less than this (P < 0.05). There was no significant correlation between age, country of practice, surgical specialty and any of the burnout subscales. Conclusion:, Female surgeons, surgeons that work in smaller hospitals, those that work more than 60 h per week, and those with practice division between the private and public sectors, are at a particularly high risk of burnout. Further enquiry into potentially remediable causes for the increased burnout in these groups is indicated. [source]

Twin deliveries and place of birth in NSW 2001,2005

AUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 5 2009
Charles S. ALGERT
Background:, Twin pregnancies have an elevated risk of adverse outcomes, particularly preterm twins. Aims:, Describe the distribution of twin deliveries by hospital level, the associated perinatal and maternal morbidity, and determine predictors of perinatal morbidity and urgent transfer to a neonatal intensive care unit. Methods:, Longitudinally linked New South Wales delivery and hospital records for the years 2001,2005 were used to identify perinatal and maternal morbidity/mortality in twin pregnancies. Regression analysis was used to examine predictive factors, including birth hospital volume. Results:, At , 32 weeks, 88.1% of twins were delivered in tertiary referral hospitals. By 34,35 weeks, only 39.7% of twins were delivered in tertiary units. Gestational age was the primary predictor of perinatal morbidity/mortality. Perinatal morbidity/mortality and maternal morbidity were lowest for deliveries at 38 weeks. There was no evidence that planned caesarean section at , 38 weeks was protective against perinatal morbidity/mortality. There was an increased risk of perinatal morbidity/mortality (odds ratio (OR) = 2.22) for twins delivered at 33,35 weeks gestation at hospitals with < 500 deliveries per annum, and an increased risk of urgent neonatal transfer (OR = 2.06). Twin pairs for whom there was a , 20% discordance in birthweight had an increased risk of morbidity/mortality at 36,38 weeks (OR = 1.79). Conclusions:, Both infant and maternal morbidity increase from 39 weeks gestation. Delivery of twins before 36 weeks at smaller hospitals (< 500 deliveries per annum) should be avoided. A twin pregnancy where there is a , 20% difference in estimated fetal weights should be considered for referral to a tertiary obstetric unit. [source]