...Methods Design and setting We performed a longitudinal retrospective patient record review study in 21 randomly sampled hospitals in 2004, and 20 in 2008 out of the total of 93 Dutch hospitals. Eight hospitals were studied in both years. Both samples were stratified for hospital type, university, tertiary teaching and general hospitals, and a proper representation of both urban and rural settings in the samples were verified. Tertiary teaching hospitals in The Netherlands provide specialised care and train doctors. The level of care given is between that given in a university hospital and in a general hospital. Generally speaking, university hospitals and, to some extent, tertiary teaching hospitals tend to treat more complex patients with more complex care. To be eligible, hospitals had to have at least 200 beds and an intensive care unit. In each hospital, 400 patient admissions were randomly selected in 2004, and 200 in 2008. Fifty percent of the records were of patients who were discharged from the hospital after a stay of at least 24 h. The other 50% were of patients who died in hospital. These patients were sampled from all inpatient deaths, regardless of their length of stay. We did not exclude patients admitted with an explicitly palliative care plan; this information was noted down and taken into account during the review process. During analysis, overall AE rates were corrected for the oversampling of deceased patients, because in our sample, 50% of the patients were...
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...Disruptive Clinician Behavior and the Effect on Patient Outcomes Abstract Hostility and disruptive behavior within healthcare facilities have been identified as factors that may contribute to poor patient outcomes. Studies have been conducted that have assessed bad behavior on the part of patients and patients’ families, but of more recent concern are disruptive behaviors by physicians and other healthcare workers. In an effort to reduce the frequency of these incidents of disruptive behavior mandates have been issued regarding the implementation of policies and procedures which specifically address disruptive behavior among healthcare workers. The aim of this paper is to review research relevant to frequency of disruptive behavior among healthcare workers, the effect of this type of behavior on clinical outcomes, and efforts to decrease its incidence. Disruptive Behavior is a Cause of Poor Patient Outcomes Disruptive behavior has been recently defined by the American Medical Association, and The Joint Commission now requires the facilities they accredit to create a plan to outline acceptable behaviors, unacceptable behaviors and how they will address the latter (Rosenstein & O’Daniel, 2005.) Members of the healthcare team should receive training in regards to an organization’s Code of Conduct. Causes of disruptive behavior may include a culture of power among physicians, a culture of oppression among nurses (especially female nurses when dealing with...
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...Sleep Deprivation The OR is a silent room. My surgical scrubs feel warm, like a pair of comfy pajamas. I sit, holding tools, while the surgeon meticulously dissects the patient's. It's a surgery I've assisted on dozens of times before. I blink and try to remember how long I have been in here. It seems like it has been forever since I have arrived at the hospital. In fact, it's been more than thirty hours since my shift started. During this past day and a half, I've logged more than fifteen hours in the OR and had no sleep in-between. My eyelids feel heavy, as if being pulled down by an invisible force. I begin shaking my knee up and down, an attempt to keep myself awake. My knee stops, and the Heaviness returns to my eyelids. Five minutes...
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...an ethnographic study involving analysis of emergency department handover in a US hospital. The study found that interruptions within the emergency department were prevalent and diverse in nature and that there were gaps in information flow due to multi-tasking and shift changes. The communication process is complex and cognitively taxing during and after team handover, that can compromise patient safety. The study also discusses the need to tailor generic electronic tools to support adaptive processes like multi-tasking and handoffs in time constrained environments. Arora et al (2005) conducted interviews using the critical incident technique to handover failures between inpatient physicians in a US hospital. The study interviewed 26 interns and found 25 discrete incidents. The 21 worst events are described. Omitted contents and failure prone communication processes were identified as a major category of failure in communication. These may result in inefficient or sub-optimal care, leading to patient harm....
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...Professional Development of Nursing Professionals Candace Tiley Grand Canyon University April 21, 2013 Professional Development of Nursing Professionals The nursing profession represents one of the largest work forces in the nation with more than 3 million members. In 2008, the Robert Wood Johnson Foundation (RWJF) partnered with the Institute of Medicine (IOM) and began 2 years of research to develop a thorough report on the future of nursing. As we move closer to the implementation of the Affordable Care Act (ACA) of 2010, nurses will be asked to take on the task of transforming the nursing workforce and expanding the delivery of nursing care. (Montalvo, 2010) We, as nurses, are in an important and unique position in that we are the segment of the healthcare field who addresses patient care both in a holistic realm as well as a contextual realm. The purpose of this paper is to look at three aspects of the IOM research and its implications. Nurses Scope of Practice is one of the key areas that the IOM put its focus upon. One of the ways the IOM anticipates changes imminently at hand is that nurses will be required to function to the full extent of their training and education no matter what level of education they currently have. The nursing profession is plagued by polices that are outdated. This is particularly true with regard to the policies regarding Scope of Practice. Much focus is being placed on APRN’s (Advanced Practice Registered Nurses) to act...
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...Chapter 33. Professional Communication and Team Collaboration Michelle O’Daniel, Alan H. Rosenstein Background In today’s health care system, delivery processes involve numerous interfaces and patient handoffs among multiple health care practitioners with varying levels of educational and occupational training. During the course of a 4-day hospital stay, a patient may interact with 50 different employees, including physicians, nurses, technicians, and others. Effective clinical practice thus involves many instances where critical information must be accurately communicated. Team collaboration is essential. When health care professionals are not communicating effectively, patient safety is at risk for several reasons: lack of critical information, misinterpretation of information, unclear orders over the telephone, and overlooked changes in status.1 Lack of communication creates situations where medical errors can occur. These errors have the potential to cause severe injury or unexpected patient death. Medical errors, especially those caused by a failure to communicate, are a pervasive problem in today’s health care organizations. According to the Joint Commission (formerly the Joint Commission on Accreditation of Healthcare Organizations, JCHAO), if medical errors appeared on the National Center for Health Statistic’s list of the top 10 causes of death in the United States, they would rank number 5—ahead of accidents, diabetes, and Alzheimer’s disease, as well as AIDS, breast...
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...Running Head: CHRONIC CONSTIPATION TREATMENT Prucalopride for the treatment of chronic constipation in women in whom laxatives fail to provide adequate relief [Name of the Writer] [Name of the Institution] Prucalopride for the treatment of chronic constipation in women in whom laxatives fail to provide adequate relief Structured Abstract The literature analysis was carried out to determine the degree to explore former researches that have been carried out in the area of the usage of Prucalopride. In this regard, the usage and utility of Prucalopride was explored with reference to women who do not respond to the usage of laxatives in chronic constipation cases. An exploration of a vast volume of research established that the usage of Prucalopride has been explored extensively but there is a lack of literature that pertains to the usage of Prucalopride with regard to women in particular. Through a sequential elaboration of chronic constipation, chronic constipation in women, and an exploration of the trends that have come forth in the experimentation that has been carried out to ascertain the utility of Prucalopride for women where laxatives have not yielded results; it was revealed that there is a lack of extended experimentation in the area. Background Constipation Constipation is generally observed in western societies and it is not an uncommon recording in clinical practices. Due to the high frequency of the occurrence of constipation, it is generally...
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...Homeopathy: An alternative means of Treatment Nicoline Lami Edie Langston University Introduction Homeopathy is an alternative medicine developed more than 200 years ago in Germany at the end of the 18th century by Dr Samuel Hahneman. This natural healing system is based on the theory “of like cures like” wherein an actual substance that produces symptoms in a healthy person can stimulate self-healing of similar symptoms in a sick person. Plants, minerals and animals are compounded into different forms such as ointment gels, drops, creams and tablets. The word homeopathy comes from the Greek word; “homeos”, which means similar and “pathos”, meaning disease (Wyatt, Sikorskii & You, 2013, p. 34). Our rationale for choosing this topic is our desire to broaden our knowledge on the intricacies of homeopathy. It is a concept that eludes us as nursing students. As people who collectively have as final goal to provide health care to the population in general, it will be of interest to know what other forms of complementary medicines our clients are using. In addition, people who use homeopathic medicine do so while still actively seeking the services of medical practitioners or cannot afford conventional medicine or better still because it is a practice that has been handed to them from generation to generation. According to Zimmerman (2012), 30% of nurse-midwives in North Carolina recommended Statistical data suggest that homeopathy is a well-known...
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...tubes (ETT), are used to maintain patient airway access during surgical procedures. The design presented here addresses a current need of the gold standard ETT by allowing for the passage of a larger bronchoscope through the inner lumen of the ETT while keeping outer dimensions constant. This design incorporates a flexible membrane with a wavy geometry to ensure a return to the neutral axis, thus allowing for even ventilation of both lungs. Flow tests simulating surgical ventilation conditions were conducted. These results confirmed that adequate air flow could be obtained independent of any pressure differences across the membrane. Tests of the prototype also confirmed that maximum instrumentation diameter was increased through this design when compared to a commercially available ETT with identical outer dimensions (35 Fr). Finite element analysis was conducted to determine the necessary thickness of the membrane for a safe design. One key design feature of the membrane is that its state of maximum deflection (2.1mm) does not significantly hinder airflow through the smaller lumen. Tests to further evaluate the functional requirements of safety and ease of use are currently under way. Methods of manufacturing this design are also under investigation. Keywords: endotracheal tube, flexible membrane, airway access, neutral axis INTRODUCTION Endotracheal tubes (ETT) are used to maintain patient airway access during surgical procedures. During thoracic surgery it is often necessary to...
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...ensure its accuracy, this publication can in no way be regarded as a substitute for professional legal or financial advice and no responsibility is accepted for any errors or omissions. The ama does not warrant the accuracy or currency of any information in this publication. The australian medical association limited disclaims liability for all loss, damage, or injury, financial or otherwise, suffered by any persons acting upon or relying on this publication or the information contained in it, whether resulting from its negligence or from the negligence of employees, agents or advisers or from any cause whatsoever. cOPyriGhT This publication is the copyright of the australian medical association limited. Other than for bona fide study or research purposes, reproduction of the whole or part of it is not permitted under the copyright act 1968, without the written permission of the australian medical association limited. safe handover : safe patients guidance on clinical handover for clinicians and managers PREPARED BY THE AUSTRALIAN MEDICAL ASSOCIATION LIMITED ABN: 37 008 426 793 2006 Adapted from the British Medical Association’s resource ‘Safe Handover: Safe Patients.’ Dr Mukesh Haikerwal President, Australian Medical Association Dr Geoff Dobb Chair, AMA Coordinating Committee of Salaried Doctors Dr Tanveer Ahmed Chair, AMA Council of Doctors-in-Training 2 SAFE HANDOVER – SAFE PATIENTS FOREWORD Clinical Handover is one of the most important issues...
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...Biomedical scientist: Job description More in this section Job description Salary and conditions Entry requirements Training Career development Employers and vacancy … Related jobs Print all pages in this section Case studies Biomedical scientist: Ann Thomas Biomedical scientist: Kathryn Owen Biomedical scientist: Roslyn Cooke Biomedical scientists work in healthcare and carry out a range of laboratory tests and techniques on tissue samples and fluids to help clinicians diagnose diseases. They also evaluate the effectiveness of treatments. Their work is extremely important for many hospital departments and the functions they carry out are wide ranging. For example, they may work on medical conditions, such as cancer, diabetes, AIDS, malaria, food poisoning or anaemia, or carry out tests for emergency blood transfusions or to see if someone has had a heart attack. Biomedical scientists can work in three areas: infection sciences; blood sciences; and cellular sciences. Infection sciences include: •medical microbiology - identification of micro-organisms causing disease and their antibiotic treatment; •virology - identification of viruses, associated diseases and monitoring the effectiveness of vaccines. Blood sciences include: •clinical chemistry - analysis of body fluids and toxicology studies; •transfusion science - determination of donor/recipient blood compatibility, ensuring blood banks are sufficient; •haematology - form...
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...advanced, more effective, and in many cases, more costly than ever before. Furthermore there is an ever increasing demand for high technology diagnostic and therapeutic health care facilities and their availability may come into conflict with medical necessity, social justice and cost effectiveness. There is increasing pressure on health care resources that is driving more explicit and public decisions regarding the best use of these resources. The complexity of modern technology and its high marginal cost suggest to us that testimonial reviews of new technologies are no longer sufficient.1 Current trends in health care decision making favour a transition from a rationale based primarily on resources and opinion to a rationale derived from research. In developing a new health care technology it is important to recognize its potential impact. The important question would be whether the new technology provides information that was not previously available and the new information may result in the cure of a common and otherwise fatal disease....
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...Using Simulation Modeling to Improve Patient Flow at an Outpatient Orthopedic Clinic Thomas R. Rohleder, PhD Division of Health Care Policy and Research Mayo Clinic 200 First Street SW Rochester, Minnesota 55905 tel: 507-538-1532 Email: rohleder@mayo.edu Peter Lewkonia, MD Faculty of Medicine University of Calgary Calgary, Alberta Diane Bischak, PhD Haskayne School of Business University of Calgary Calgary, Alberta Paul Duffy, MD Faculty of Medicine University of Calgary Calgary, Alberta Rosa Hendijani Haskayne School of Business University of Calgary Calgary, Alberta July 2011 Abstract We report on the use of discrete event simulation modeling to support process improvements at an orthopedic outpatient clinic. The clinic was effective in treating patients, but waiting time and congestion in the clinic created patient dissatisfaction and staff morale issues. The modeling helped to identify improvement alternatives including optimized staffing levels, better patient scheduling, and an emphasis on staff arriving promptly. Quantitative results from the modeling provided motivation to implement the improvements. Statistical analysis of data taken before and after the implementation indicate that waiting time measures were significantly improved and overall patient time in the clinic was reduced. Keywords: Outpatient Clinic, Discrete Event Simulation, Process Improvement, Patient Waiting I. Introduction Visiting hospital outpatient clinics is a very common way for...
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...Using Simulation Modeling to Improve Patient Flow at an Outpatient Orthopedic Clinic Thomas R. Rohleder, PhD Division of Health Care Policy and Research Mayo Clinic 200 First Street SW Rochester, Minnesota 55905 tel: 507-538-1532 Email: rohleder@mayo.edu Peter Lewkonia, MD Faculty of Medicine University of Calgary Calgary, Alberta Diane Bischak, PhD Haskayne School of Business University of Calgary Calgary, Alberta Paul Duffy, MD Faculty of Medicine University of Calgary Calgary, Alberta Rosa Hendijani Haskayne School of Business University of Calgary Calgary, Alberta July 2011 Abstract We report on the use of discrete event simulation modeling to support process improvements at an orthopedic outpatient clinic. The clinic was effective in treating patients, but waiting time and congestion in the clinic created patient dissatisfaction and staff morale issues. The modeling helped to identify improvement alternatives including optimized staffing levels, better patient scheduling, and an emphasis on staff arriving promptly. Quantitative results from the modeling provided motivation to implement the improvements. Statistical analysis of data taken before and after the implementation indicate that waiting time measures were significantly improved and overall patient time in the clinic was reduced. Keywords: Outpatient Clinic, Discrete Event Simulation, Process Improvement, Patient Waiting I. Introduction Visiting hospital outpatient...
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...Case report: Paediatric Orthopaedic Clinic 1- What is capacity utilization at every step in the process? What is the direct resource utilization? Using the data provided in the case, we are able to compile all data necessary to compute the capacity utilization at the clinic. Activity | # of Staff | Available time | Activity time | Number of Patients | Time needed | Utilization10 | | | /Staff | Total | N | F | N | F | N | F | Total | | 1. Front Desk | | | | | | | | | | | | a. Registration | 3 | 180 | 540 | 5 | 5 | 32 | 48 | 160 | 240 | 400 | 74 % | b. Verification | 3 | 255 | 765 | 9 | 4 | 32 | 48 | 288 | 192 | 480 | 63 % | 2. Radiology Department | | | | | | | | | | | | a. X-ray imaging | 6 | 240 | 9603 | 11 | 11 | 32 | 40.8 | 352 | 448.8 | 800.8 | 83 % | b. Development of X-rat | -1 | 240 | 9604 | 7 | 7 | 32 | 40.8 | 224 | 285.6 | 509.6 | 53%8 | c. Diagnostic reading and comments | 3 | 240 | 4805 | 5 | 5 | 32 | 40.8 | 160 | 204 | 364 | 76% | 3. Hand-off X-ray to Clinic | | | | | | | | | | | | a. Collection of X-ray | 3 | 2556 | 7657 | 2 | 2 | 32 | 40.8 | 64 | 81.6 | 145.6 | 19% 9 | b. Filing/exam room prep | 1 | 255 | 255 | 2 | 2 | 32 | 48 | 64 | 96 | 160 | 63% | 4. Examination Room | | | | | | | | | | | | a. Surgeon | 1 | 255 | 255 | 7 | 4 | 32 | 14.4 | 224 | 57.6 | 281.6 | 110% | b. Resident | 1(2)2 | 255 | 255 | - | 7 | - | 33.6 | - | 235.2 | 235.2 | 92% | c. Cast technician...
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