Variability in Surgical Caseload and Access to Intensive Care Services

2003 ◽  
Vol 98 (6) ◽  
pp. 1491-1496 ◽  
Author(s):  
Michael L. McManus ◽  
Michael C. Long ◽  
Abbot Cooper ◽  
James Mandell ◽  
Donald M. Berwick ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Delivery System ◽  
Care Delivery ◽  
Patient Flow ◽  
Healthcare Delivery ◽  
Hospital Data ◽  
Healthcare Delivery System ◽  
Care Services

Background Variability in the demand for any service is a significant barrier to efficient distribution of limited resources. In health care, demand is often highly variable and access may be limited when peaks cannot be accommodated in a downsized care delivery system. Intensive care units may frequently present bottlenecks to patient flow, and saturation of these services limits a hospital's responsiveness to new emergencies. Methods Over a 1-yr period, information was collected prospectively on all requests for admission to the intensive care unit of a large, urban children's hospital. Data included the nature of each request, as well as each patient's final disposition. The daily variability of requests was then analyzed and related to the unit's ability to accommodate new admissions. Results Day-to-day demand for intensive care services was extremely variable. This variability was particularly high among patients undergoing scheduled surgical procedures, with variability of scheduled admissions exceeding that of emergencies. Peaks of demand were associated with diversion of patients both within the hospital (to off-service care sites) and to other institutions (ambulance diversions). Although emergency requests for admission outnumbered scheduled requests, diversion from the intensive care unit was better correlated with scheduled caseload (r = 0.542, P < 0.001) than with unscheduled volume (r = 0.255, P < 0.001). During the busiest periods, nearly 70% of all diversions were associated with variability in the scheduled caseload. Conclusions Variability in scheduled surgical caseload represents a potentially reducible source of stress on intensive care units in hospitals and throughout the healthcare delivery system generally. When uncontrolled, variability limits access to care and impairs overall responsiveness to emergencies.

scholarly journals A California Hospital’s Response to COVID-19: From a Ripple to a Tsunami Warning

2020 ◽  
Vol 40 (6) ◽  
pp. e1-e16
Author(s):  
Mary Kay Bader ◽  
Annabelle Braun ◽  
Cherie Fox ◽  
Lauren Dwinell ◽  
Jennifer Cord ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Task Force ◽  
The United States ◽  
Tsunami Warning ◽  
Care Services ◽  
Evidence Review ◽  
Excellent Care

Background The outbreak of coronavirus disease 2019 (COVID-19) rippled across the world from Wuhan, China, to the shores of the United States within a few months. Hospitals and intensive care units were suddenly faced with a “tsunami” warning requiring instantaneous implementation and escalation of disaster plans. Evidence Review An evidence-based question was developed and an extensive review of the literature was completed, resulting in a structured plan for the intensive care units to manage a surge of patients critically ill with COVID-19 in March 2020. Twenty-five sources of evidence focusing on pandemic intensive care unit and COVID-19 management laid the foundation for the team to navigate the crisis. Implementation The Critical Care Services task force adopted recommendations from the CHEST consensus statement on surge capacity principles and other sources, which served as the framework for the organized response. The 4 S’s became the focus: space, staff, supplies, and systems. Development of algorithms, workflows, and new processes related to treating patients, staffing shortages, and limited supplies. New intensive care unit staffing solutions were adopted. Evaluation Using a framework based on the literature reviewed, the Critical Care Services task force controlled the surge of patients with COVID-19 in March through May 2020. Patients received excellent care, and the mortality rate was 0.008%. The intensive care unit team had the needed respiratory and general supplies but had to continually adapt to shortages of personal protective equipment, cleaning products, and some medications. Sustainability The intensive care unit pandemic response plan has been established and the team is prepared for the next wave of COVID-19.

A Multidisciplinary Remote Healthcare Delivery System to Increase Health Care Access, Pathology Screening, and Treatment in Developing Countries

2019 ◽  
pp. 1376-1409
Author(s):  
Thierry Oscar Edoh ◽  
Pravin Amrut Pawar ◽  
Bernd Brügge ◽  
Gunnar Teege
Keyword(s):  
Health Care ◽  
Delivery System ◽  
Health Care Access ◽  
Care Delivery ◽  
Healthcare Delivery ◽  
Access To Healthcare ◽  
Healthcare Delivery System ◽  
Care Access ◽  
Traditional Practitioners ◽  
Remote Care

In this paper, the authors describe a case study of the poor access to healthcare in developing world, case of Benin, a West African developing country. The authors identify problems and the existing obstacles for applying standard Telemedicine and eHealth solutions. The authors particularly describe an adapted multidisciplinary remote care delivery system approach for improving and increasing the use of existing health services as well as the access to healthcare by overcoming some cultural, social, financial, and at least linguistic barriers. The multidisciplinary remote care delivery system integrates traditional practitioners, because most people are more confident with the traditional medicine. The authors further present a practical test which has shown that their approach has the potential to improve the quality and effectiveness of health care in rural and other concerned regions and also increase the accessibility to health care system.

A Multidisciplinary Remote Healthcare Delivery System to Increase Health Care Access, Pathology Screening, and Treatment in Developing Countries

2017 ◽  
pp. 269-302
Author(s):  
Thierry Oscar Edoh ◽  
Pravin Amrut Pawar ◽  
Bernd Brügge ◽  
Gunnar Teege
Keyword(s):  
Health Care ◽  
Delivery System ◽  
Health Care Access ◽  
Care Delivery ◽  
Healthcare Delivery ◽  
Access To Healthcare ◽  
Healthcare Delivery System ◽  
Care Access ◽  
Traditional Practitioners ◽  
Remote Care

In this paper, the authors describe a case study of the poor access to healthcare in developing world, case of Benin, a West African developing country. The authors identify problems and the existing obstacles for applying standard Telemedicine and eHealth solutions. The authors particularly describe an adapted multidisciplinary remote care delivery system approach for improving and increasing the use of existing health services as well as the access to healthcare by overcoming some cultural, social, financial, and at least linguistic barriers. The multidisciplinary remote care delivery system integrates traditional practitioners, because most people are more confident with the traditional medicine. The authors further present a practical test which has shown that their approach has the potential to improve the quality and effectiveness of health care in rural and other concerned regions and also increase the accessibility to health care system.

Developing a Charter of Spiritual Care for patients

2020 ◽  
Author(s):  
Akram Heidari ◽  
Abdolhasan Kazemi ◽  
Mohammad Abbasi ◽  
Seyed Hasan Adeli ◽  
Hoda Ahmari-Tehran ◽  
...  
Keyword(s):  
Literature Review ◽  
Delivery System ◽  
Expert Opinion ◽  
Systematic Literature Review ◽  
Spiritual Care ◽  
Care Delivery ◽  
Healthcare Delivery ◽  
Healthcare Providers ◽  
Spiritual Needs ◽  
Healthcare Delivery System

Abstract Background Spirituality is recognized as an important issue in healthcare, and every individual has spiritual needs. Despite increased knowledge about spiritual care and its necessity, there is no unique agreed upon framework for spiritual care among the practitioners. This study aimed to explore the concept from the viewpoint of both healthcare providers and patients within the Iranian social, cultural and overall context and present a charter for providing spiritual care. Methods The study consisted of a systematic literature review, two qualitative studies on the components of spiritual care from the perspective of healthcare providers and its dimensions as perceived by patients. The findings were then integrated to make up a charter draft that was accredited through expert opinion. Results The review of literatures led to the identification of 2 main themes and 10 themes. Perspectives of healthcare providers were categorized into 4 main themes and 10 themes and patients’ opinions were classified into 3 main themes and 11 themes. The themes and their subthemes were integrated to build the concepts and form the proposed charter with 30 statements. Conclusion The charter of spiritual care for patients is intended to present an agreed upon framework for spiritual care delivery and resolve some of the problems in this path. This can improve healthcare delivery system.

scholarly journals Equity of access to critical care services in Scotland: A Bayesian spatial analysis

2020 ◽  
pp. 175114372091446
Author(s):  
Philip Emerson ◽  
David R Green ◽  
Steve Stott ◽  
Graeme Maclennan ◽  
Marion K Campbell ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Spatial Analysis ◽  
Intensive Care Units ◽  
Geographical Variation ◽  
Admission Rates ◽  
Care Services ◽  
Co Morbidity ◽  
Bayesian Spatial Analysis

Background There is increasing evidence that access to critical care services is not equitable. We aimed to investigate whether location of residence in Scotland impacts on the risk of admission to an Intensive Care Unit and on outcomes. Methods This was a population-based Bayesian spatial analysis of adult patients admitted to Intensive Care Units in Scotland between January 2011 and December 2015. We used a Besag–York–Mollié model that allows us to make direct probabilistic comparisons between areas regarding risk of admission to Intensive Care Units and on outcomes. Results A total of 17,596 patients were included. The five-year age- and sex-standardised admission rate was 352 per 100,000 residents. There was a cluster of Council Areas in the North-East of the country which had lower adjusted admission rates than the Scottish average. Midlothian, in South East Scotland had higher spatially adjusted admission rates than the Scottish average. There was no evidence of geographical variation in mortality. Conclusion Access to critical care services in Scotland varies with location of residence. Possible reasons include differential co-morbidity burden, service provision and access to critical care services. In contrast, the probability of surviving an Intensive Care Unit admission, if admitted, does not show geographical variation.

Trauma care strategies for changing economic forces

1997 ◽  
Vol 17 (6) ◽  
pp. 81-89 ◽  
Author(s):  
MB Flynn ◽  
J Luchsinger
Keyword(s):  
Delivery System ◽  
Trauma Care ◽  
Healthcare Delivery ◽  
Healthcare Services ◽  
Healthcare Delivery System ◽  
Optimal Position ◽  
Traumatic Injuries ◽  
Optimal Outcomes ◽  
Care Services ◽  
Economic Forces

Nurses have expertise in wellness, health promotion, delivery of acute care, and rehabilitation. As the venture into healthcare reform deepens, nurses must take a more proactive role in redirecting the delivery of trauma care in such a way that optimal provision of healthcare services is maintained while costs of providing care are reduced across the continuum of care. Efforts must focus on preventing traumatic injuries, restructuring healthcare delivery systems to meet the needs of patients with traumatic injuries, and reducing healthcare expenditures. Table 3 outlines strategies used by our facility to decrease cost without compromising patients' care. The current era is fraught with rapid changes that necessitate a creative, rational, and organized approach to making decisions about the delivery system for patient-focused care. Nurses are in an optimal position to develop and implement interdisciplinary, creative strategies that will maximize the delivery of trauma care services to the community. Each institution must evaluate the processes involved in its delivery of trauma care services. Strategies to contain costs must focus on processes implemented to achieve optimal outcomes of patients' care. The economic marketplace will evaluate care on the basis of outcome statistics and cost analysis. Thus, nurses must continue to be critical evaluators of nursing practice, always striving for the best healthcare delivery system possible during these turbulent economic times.

scholarly journals Understanding the Nigerian Healthcare Delivery System: A Paradox of Preventive Medicine Since the Colonial Epoch

2019 ◽  
pp. 1-9
Author(s):  
Iroju Opeyemi Anthony
Keyword(s):  
Delivery System ◽  
Preventive Medicine ◽  
Care Delivery ◽  
Healthcare Delivery ◽  
Colonial Period ◽  
Human Society ◽  
New Paradigm ◽  
Healthcare Delivery System ◽  
Colonial Era ◽  
Healthcare Facilities

No human society is mundane to healthcare delivery method. Apparently, the process of healthcare delivery depicts the extent of the social development of a particular society. However, the healthcare delivery process in Nigeria from the colonial era attained a new paradigm by shifting from the practice of traditional medicine to the western styled patterns. Since the colonial Nigeria, both the traditional and western medicine has been dependable sources of preventive medicine for the Nigeria populace. In spite of the outright condemnation of the traditional healthcare practices, it received unbridled patronage by a larger Nigeria populace, thus the post-independence Nigeria witnessed a paradox of health care delivery. Aim: This paper aims to provide an understanding on the revolutions in the healthcare delivery system in Nigeria since the colonial period. Methodology: An extensive review of literature was carried out to elicit information on the Nigerian healthcare delivery since the colonial period. Results: The study revealed that the Nigerian healthcare delivery system is characterized by high cost. The study also showed that Nigeria has been witnessing inequitable distribution of healthcare facilities since the colonial period. Conclusion: The healthcare delivery system in Nigeria is not a colonial invention but the advent of the colonial masters brought about an outstanding transformation in the healthcare delivery process of most Nigerian societies. Thus, the practice of preventive medicine is indigenous to the Nigerian people.

A Multidisciplinary Remote Healthcare Delivery System to Increase Health Care Access, Pathology Screening, and Treatment in Developing Countries

2016 ◽  
Vol 11 (4) ◽  
pp. 1-31 ◽  
Author(s):  
Thierry Oscar Edoh ◽  
Pravin Amrut Pawar ◽  
Bernd Brügge ◽  
Gunnar Teege
Keyword(s):  
Health Care ◽  
Delivery System ◽  
Health Care Access ◽  
Care Delivery ◽  
Healthcare Delivery ◽  
Access To Healthcare ◽  
Healthcare Delivery System ◽  
Remote Healthcare ◽  
Traditional Practitioners ◽  
Remote Care

In this paper, the authors describe a case study of the poor access to healthcare in developing world, case of Benin, a West African developing country. The authors identify problems and the existing obstacles for applying standard Telemedicine and eHealth solutions. The authors particularly describe an adapted multidisciplinary remote care delivery system approach for improving and increasing the use of existing health services as well as the access to healthcare by overcoming some cultural, social, financial, and at least linguistic barriers. The multidisciplinary remote care delivery system integrates traditional practitioners, because most people are more confident with the traditional medicine. The authors further present a practical test which has shown that their approach has the potential to improve the quality and effectiveness of health care in rural and other concerned regions and also increase the accessibility to health care system.

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