scholarly journals The Integration of Adult Acute Care Surgeons into Pediatric Surgical Care Models Supplements the Workforce without Compromising Quality of Care

2015 ◽  
Vol 81 (9) ◽  
pp. 854-858 ◽  
Author(s):  
Rudy J. Judhan ◽  
Raquel Silhy ◽  
Kristen Statler ◽  
Mija Khan ◽  
Benjamin Dyer ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Acute Care ◽  
Tertiary Care ◽  
Disease Process ◽  
Pediatric Care ◽  
Care Hospital ◽  
Late Night ◽  
General Surgeons ◽  
The Impact

Acute care of children remains a challenge due to a shortage of pediatric surgeons, particularly in rural areas. In our institutional norm, all cases in patients age six and older are managed by dedicated general surgeons. The provision of care to these children by these surgeons alleviates the impact of such shortages. We conducted a five-year retrospective analysis of all acute care pediatric surgical cases performed in patients aged 6 to 17 years by a dedicated group of adult general surgeons in a rural tertiary care hospital. Demographics, procedure, complications, outcomes, length of stay, and time of consultation/operation were obtained via chart review. Elective, trauma related, or procedures performed by a pediatric surgeon were excluded. Descriptive statistics are reported. A total of 397 cases were performed by six dedicated general surgeons during the study period. Mean age was 11.5 ± 3.1 years. In all, 100 (25.2%) were transferred from outlying facilities and 52.6 per cent of consultations/operations occurred at night (7P–7A), of which 33.2 per cent occurred during late night hours (11P–7A). On weekends, 34.0 per cent occurred. Appendectomy was the most commonly performed operation (n = 357,89.9%), of which 311 were laparoscopic (87.1%). Others included incision/drainage (4.5%), laparoscopic cholecystectomy (2.0%), bowel resection (1.5%), incarcerated hernia (0.5%), small bowel obstruction (0.5%), intraabdominal abscess drainage (0.3%), resection of intussusception (0.3%), Graham patch (0.3%), and resection omental torsion (0.3%). Median length of stay was two days. Complications occurred in 23 patients (5.8%), of which 22(5.5%) were the result of the disease process. These results parallel those published by pediatric surgeons in this age group and for the diagnoses treated. Models integrating dedicated general surgeons into pediatric call rotations can be designed such that quality of pediatric care is maintained while providing relief to an overburdened pediatric surgical workforce.

Cognitive Impairment and Length of Stay in Acute Care Hospitals: A Scoping Review of the Literature

2021 ◽  
pp. 1-19
Author(s):  
Jonathan Plante ◽  
Karine Latulippe ◽  
Edeltraut Kröger ◽  
Dominique Giroux ◽  
Martine Marcotte ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Length Of Stay ◽  
Acute Care ◽  
Scoping Review ◽  
Research Question ◽  
Positive Association ◽  
Well Being ◽  
Future Research ◽  
Care Hospital ◽  
The Impact

Abstract Older persons experiencing a longer length of stay (LOS) or delayed discharge (DD) may see a decline in their health and well-being, generating significant costs. This review aimed to identify evidence on the impact of cognitive impairment (CI) on acute care hospital LOS/DD. A scoping review of studies examining the association between CI and LOS/DD was performed. We searched six databases; two reviewers independently screened references until November 2019. A narrative synthesis was used to answer the research question; 58 studies were included of which 33 found a positive association between CI and LOS or DD, 8 studies had mixed results, 3 found an inverse relationship, and 14 showed an indirect link between CI-related syndromes and LOS/DD. Thus, cognitive impairment seemed to be frequently associated with increased LOS/DD. Future research should consider CI together with other risks for LOS/DD and also focus on explaining the association between the two.

THE IMPACT OF ANTIMICROBIAL STEWARDSHIP ON THE PATTERNS OF ANTIBIOTICS’ PRESCRIPTION AND CLINICAL OUTCOMES IN THE MEDICAL WARD OF A MALAYSIAN TERTIARY CARE HOSPITAL

2021 ◽  
pp. 20-25
Author(s):  
OVAIS ULLAH SHIRAZI ◽  
NORNY SYAFINAZ AB RAHMAN ◽  
CHE SURAYA ZIN ◽  
HANNAH MD MAHIR ◽  
SYAMHANIN ADNAN
Keyword(s):  
Length Of Stay ◽  
Clinical Outcomes ◽  
Antimicrobial Stewardship ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Medical Ward ◽  
Prescribing Patterns ◽  
Care Hospital ◽  
Slope Change ◽  
The Impact

Objective: To evaluate the impact of antimicrobial stewardship (AMS) on antibiotic prescribing patterns and certain clinical outcomes, the length of stay (LOS) and the re-admission rate (RR) of the patients treated within the medical ward of a tertiary care hospital in Malaysia. Methods: This quasi-experimental study was conducted retrospectively. The prescriptions of the AMS included alert antibiotics (AA) such as cefepime, ceftazidime, colistin (polymyxin E), imipenem-cilastatin, meropenem, piperacillin-tazobactam and vancomycin were reviewed for the period of 24 mo before (May, 2012–April, 2014) and after (May, 2014–April, 2016) the AMS implementation for the patients who were treated within the medical ward of a Malaysian tertiary care hospital. Patterns of antibiotics prescribed were determined descriptively. The impact of the AMS on the length of stay (LOS) and readmission rate (RR) was determined by the interrupted time series (ITS) comparative analysis of the pre-and post-AMS segments segregated by the point of onset (May, 2014) of the AMS program. Data analysis was performed through autoregressive integrated moving average (ARIMA) Winter Additive model and the Games-Howell non-parametric post hoc test by using IBM Statistical Package for Social Sciences version 25.0 for Windows (SPSS Inc., Chicago, IL, USA). Results: A total of 1716 prescriptions of the AA included for the AMS program showed that cefepime (623, 36.3%) and piperacillin-tazobactam (424, 24.7%) were the most prescribed antibiotics from May 2012 to April 2016. A 23.6% drop in the number of the AA prescriptions was observed during the 24-month post-AMS period. The LOS of the patients using any of the AA showed a post-AMS decline by 3.5 d. The patients’ LOS showed an average reduction of 0.12 (95% CI, 0.05–0.19, P=0.001) with the level and slope change of 0.18 (95% CI, 0.04–0.32, P=0.02) and 0.074 (95% CI, 0.02–0.12, P=0.002), respectively. Similarly, the percent RR reduced from 20.0 to 9.85 during the 24-month post-AMS period. The observed post-AMS mean monthly reduction of the RR for the patients using any AA was 0.38 (95% CI, 0.23–0.53, P<0.001) with the level and slope change of 0.33 (95% CI, 0.14–0.51, P=0.02) and 0.37 (95% CI, 0.16–0.58, P=0.001), respectively. Conclusion: The AMS program of a Malaysian tertiary care hospital was a coordinated set of interventions implemented by the AMS team of the hospital that comprised of the infectious diseases (ID) physician, clinical pharmacists and microbiologist. The successful implementation of the AMS program from May, 2014 to April, 2016 within the medical ward resulted in the drop of the number of AA prescriptions that sequentially resulted in the significant (P<0.05) post-AMS reduction of the LOS and the RR.

scholarly journals Impact of UV-Light Use on the Quality of Manual Cleaning and Room Turnover Times at a Large Tertiary-Care Hospital, 2019

2020 ◽  
Vol 41 (S1) ◽  
pp. s266-s267
Author(s):  
Oluchi Abosi ◽  
Stephanie Holley ◽  
Mary Kukla ◽  
Angie Dains ◽  
Kyle Jenn ◽  
...  
Keyword(s):  
Uv Light ◽  
Objective Assessment ◽  
Tertiary Care ◽  
Turnover Time ◽  
Light Cycle ◽  
Care Hospital ◽  
Cleaning Process ◽  
Contact Precautions ◽  
The Impact

Background: Manual cleaning is the recommended method of environmental disinfection; it plays a key role in the prevention of healthcare-associated infections. Recently, automated no-touch disinfection technologies, such as ultraviolet (UV) light, have been proposed as a supplement to manual cleaning. However, UV light adds time to the cleaning process and may decrease the quality of manual cleaning. We evaluated the impact of adding UV light on the quality of manual cleaning and on room turnover times. Methods: During January–September 2019, we assessed the thoroughness of disinfection cleaning (TDC) of environmental surfaces in rooms identified for discharge. According to hospital policy, contact precautions rooms use UV light after manual cleaning with an EPA-approved sporicidal agent (bleach). Non–contact precautions rooms are disinfected using quaternary ammonium only. Rooms were identified after patient admission, selected randomly, and marked once discharge orders were placed. Fluorescent markers were applied on high-touch surfaces before discharge and were assessed after the cleaning process was completed. TDC scores were defined as the percentage of cleaned surfaces of the total of examined surfaces. UV-light disinfection time is determined automatically based on room size. We compared TDC scores and manual cleaning times between contact precautions rooms and noncontact precautions rooms. We also calculated UV-light cycle durations. Results: We assessed 2,383 surfaces in 24 contact precautions rooms with UV-light disinfection and 201 noncontact precautions rooms without UV-light disinfection. The TDC score was similar in contact precautions rooms (243 of 273 surfaces) and noncontact precautions rooms (1,835 of 2,110 surfaces; 89% vs 87%). The median manual cleaning time for contact precautions rooms was 56 minutes (IQR, 37–79), and for noncontact precautions rooms the median manual cleaning time was 33 minutes (IQR, 22–43). UV-light use added a median of 49 minutes (IQR, 35–67) to the overall cleaning process. The median turnover time for contact precautions rooms was 156 minutes (IQR, 87–216) versus 58 minutes (IQR, 40–86) in noncontact precautions room. Conclusions: In a setting with an objective assessment of environmental cleaning, there was no difference in quality of manual cleaning between contact precautions rooms (UV light) and noncontact precautions rooms (UV light). Adding UV light following manual disinfection increased the overall cleaning time and delayed room availability.Funding: NoneDisclosures: None

scholarly journals Emotional Touch Points as a Predictor of Service Quality in a Tertiary Care Hospital, Chennai

2019 ◽  
Vol 8 (4S3) ◽  
pp. 134-138
Keyword(s):  
Quality Of Service ◽  
Service Quality ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Healthcare Organization ◽  
Primary Data ◽  
Emotional Engagement ◽  
Care Hospital ◽  
The Impact

The Purpose of this study is to analyze the Impact of relationship between the Five Emotional Touch points experienced at a Tertiary Care Hospital and the dimensions of Service Quality delivered by a Healthcare Organization. The Emotional Touch Points experienced by In-Patients during their stay at a Tertiary Care Hospital is under the purview of this study. This study identifies and analyses the bottlenecks experienced by the In-patients emotionally which is considered as a major impact on the Quality of Service delivered by the Healthcare Organizations. The study design is a purely descriptive design about the quality of service delivered in the process of providing In-Patient health care services. The primary data were collected through closed ended questionnaire for assessing the emotional touch points and the dimensions of Service Quality rendered by the Hospital. The statistical tools used in this study are weighted mean, correlation and regression. The results revealed that the human element -empathy expressed by the Healthcare providers towards their patients is a highly significant dimension of Service Quality reflecting on the Emotional Engagement of patients with the Healthcare Organization..

scholarly journals SP3.2.4 Creating sub-specialty emergency surgical care and changing consultant working patterns improves consultant morale and stress levels

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Edward Hardy ◽  
Thomas Smart ◽  
Jacob Hatt ◽  
Jon Lund
Keyword(s):  
Length Of Stay ◽  
Perceived Stress ◽  
General Surgery ◽  
Surgical Care ◽  
Emergency General Surgery ◽  
Quality Of Patient Care ◽  
Stress Levels ◽  
General Surgeons ◽  
The Impact

Abstract Aims General surgery consultants have some of the highest rates of burnout. Ever increasing emergency general surgery (EGS) admissions playing a major role in this. A move to create split sub-speciality cover consisting of upper GI/HPB (UGI) and colorectal (CR) consultants has been suggested to improve EGS outcomes. We assessed the impact changing on-call working patterns had on perceived consultant stress levels, manageability of their workload and patient length of stay (LOS). Methods Consultant on call patterns changed from an individual consultant covering four consecutive weekdays to two consultants (one UGI/HPB, one CR) sharing four consecutive weekdays. Consultants were surveyed to assess the impact of this change on the manageability of their workload and their perceived stress levels. Admission numbers and LOS were also analysed for all EGS admissions over a 6-month period either side of the rota change. Results 89% of consultants who responded chose to work the new on call format. 78% felt it had improved the manageability of their workload, decreased perceived stress levels and improved quality of patient care. There was no change in the number of EGS admissions (862 vs 866) or EGS patient length over the time periods studied (Pre: 0D: 8%, 1 – 2D 38%, 3 – 4D 19%, &gt;4D 34%. vs Post: 0D 8%, 1 – 2D 40%, 3 – 4D 17%, &gt; 4D 35%). Conclusions A move to shorter and sub-specialty on call duties reduced stress and improved manageability for consultant general surgeons without adverse impact on patient’s length of stay.

scholarly journals Quality of life in epilepsy

2017 ◽  
Vol 5 (2) ◽  
pp. 452 ◽  
Author(s):  
Prem Singh ◽  
Achyut Kumar Pandey
Keyword(s):  
Quality Of Life ◽  
Pearson Correlation ◽  
Tertiary Care ◽  
P Value ◽  
Care Hospital ◽  
Lower Education Level ◽  
One Year ◽  
Patients With Epilepsy ◽  
The Impact

Background: The quality of life (QOL) evaluation is a relatively new measure to evaluate the outcome of epilepsy. Many factors influence the quality of life of people with epilepsy, including seizure severity, stigma, fear, and the presence of cognitive or psychiatric problems. QOL is influenced by biological factors as well as cultural, social and religious beliefs and values. This study was planned to find out the impact of epilepsy on quality of life of epileptic patients.Methods: The study was conducted in the epilepsy clinic of department of neurology at a tertiary care hospital over a period of one year.101 patients were included after fulfilling the inclusion criteria. All the patients seeking treatment in the OPD were screened, assessed and then all procedures were fully explained to them. History regarding name, age sex, socio-demographic profile and detailed history regarding seizure disorder was taken from both the patient and the reliable informant. Bengali version of QOLIE-9 was used to assess the quality of life.Results: One hundred and one patients with epilepsy consisting of 70 men (69.3%) and 31 women (30.7%) were included. Their ages ranged from 15 to 52, the mean age being 26.17 (SD = 7.84). Out of the 101 patients, 65 patients (64.4%) were suffering from partial epilepsies and 36 patients (35.6%) were suffering from generalized epilepsies. Mean QOLIE-9 total scores were 16.66, 19.74, 20.13 and 24.00 in married, widows, unmarried and separated individuals respectively. The differences in the means were statistically significant on ANOVA (p value 0.002). Mean QOLIE-9 total scores were 27.75, 19.64, 19.65, 18.14 and 18.00 in primary, secondary, higher secondary, graduate and postgraduate individuals respectively. The differences were highly significant statistically on ANOVA (p value<0.001). Frequency of seizures per month was positively correlated with QOLIE-9 total scores (Pearson Correlation 0.622) and was highly statistically significant (p value<0.001).Conclusions: Frequent seizures, lower education level and single status are associated with lower quality of life in persons with epilepsy.

scholarly journals Quality of Life and Stigma among Women with Epilepsy during Their Reproductive Years

2021 ◽  
Vol 11 (1) ◽  
pp. 63-71
Author(s):  
Pallerla Srikanth ◽  
Mysore Narasimha Vranda ◽  
Priya Treesa Thomas ◽  
Kenchaiah Raghvendra
Keyword(s):  
Quality Of Life ◽  
Tertiary Care ◽  
Reproductive Age ◽  
Care Hospital ◽  
Age Group ◽  
Stigma Scale ◽  
The Impact ◽  
The Relationship ◽  
Reproductive Age Group

Background and Purpose: The purpose of this study was to understand the relationship between quality of life and stigma among reproductive age group women with epilepsy.Methods: A cross-sectional descriptive study was conducted to assess the data from the 49 women with epilepsy from a tertiary care hospital in India. Quality of life was evaluated with the quality of life in epilepsy-31 questionnaire and stigma was evaluated with the stigma scale of epilepsy. Data also included socio-demographic and clinical characteristics.Results: The mean age of the participants was 24.67±3.72 years. Quality of life total score (r=-0.485**) and seizure worry domain (r=-0.427**) were significantly negatively correlated with stigma total score at p<0.01 level. Being uneducated, married, unemployed, having children, having generalized tonic-clonic seizures, duration of illness (˃10 years), and consuming levetiracetam, anti-epileptic drug (AED), were the significant contributing factors for low quality of life among women with epilepsy during the reproductive age group. Belonging to lower socio-economic status and taking more than two AEDs were also associated with lower quality of life among women with epilepsy, which are trending towards significance.Conclusions: The study assessed the relationship between the quality of life and the Stigma scale of epilepsy and demonstrated the impact of stigma and quality of life on socio-demographic and clinical variables of women with epilepsy under the reproductive age group. To enhance the quality of life and reduce the stigma levels among women with epilepsy, some of the modifiable parameters can be considered by the multidisciplinary health care professionals from the findings of the current research.

The Impact of Hospital Accreditation on the Patients Satisfaction of Haemodialysis Department Services

2018 ◽  
Vol 6 (8) ◽  
pp. 384
Author(s):  
Zuber Mujeeb Shaikh
Keyword(s):  
Patient Satisfaction ◽  
Health Care Quality ◽  
Tertiary Care ◽  
Care Quality ◽  
Care Hospital ◽  
Significant Difference ◽  
Before And After ◽  
The Impact ◽  
Survey Questionnaires

The quality of hospital Haemodialysis Department Service is one of the most relevant items of health care quality perceived by patients and by their families. Patient satisfaction is considered a way of measuring the quality of services provided. Objectives: To study the impact of National Accreditation Board for Hospitals & Healthcare Providers (NABH) Accreditation, India on Haemodialysis Department Service patient satisfaction. Methods: It is a quantitative, descriptive and inferential research based case study in which sample of a population was studied by structured satisfaction survey questionnaires (before and after the accreditation) in a private tertiary care hospital at Secunderabad, Telangana State, India to determine its characteristics, and it is then inferred that the population has the same or different characteristics. Significance of Research: It was observed initially before the accreditation that there was a lower patient satisfaction rate of the hospital Haemodialysis Department Services, which was affecting the study hospitals’ business. Hypothesis: Null Hypothesis (Ho) and Alternative Hypothesis (H1) were used and tested to compare the before and after impact of accreditation by applying to each question in the questionnaire. Study Design: The closed ended questionnaire was developed considering the Haemodialysis Department Services and incorporated the six dimensions of quality Safe, Timely, Effective, Efficient, Equitable, and Patient-centred (STEEP) and tested prior to implementing. Questionnaires were given to the patients' families for completion upon using the Haemodialysis Department Services two months before and two months after the accreditation. The data were collected in order to cover all three shifts of the Haemodialysis Department Services. Study Population: Simple random sampling method was selected, the researcher had involved all conscious patients (clinical conditions) from all age groups. Data Collections: Primary data were collected from the survey questionnaires. Secondary data were collected from relevant published journals, articles, research papers, academic literature and web portals. Conclusion: At the 5 % level of significance, the t-test results indicate that there is a significant difference in the responses between before (M=51.11, SD=21.89) and after accreditation (M=58.56, SD=17.28) with p-value <0.001. The mean satisfaction score has improved from before accreditation compared to after accreditation.

scholarly journals To study the impact of design considerations on customer satisfaction in a dialysis facility of a super-specialty tertiary care hospital in Delhi, India

2017 ◽  
Vol 5 (6) ◽  
pp. 2563
Author(s):  
Namrata Makkar ◽  
Kanika Jain
Keyword(s):  
Structural Changes ◽  
Tertiary Care ◽  
Disease Patient ◽  
Care Facility ◽  
North India ◽  
Care Hospital ◽  
Waiting Room ◽  
Dialysis Unit ◽  
The Impact

Background: In recent times, patient focused hospital architecture is gaining attention. The current scenario demands to provide living spaces for families rather than ware houses for the sick. Attitudes, aspiration and values of the society must be clearly understood while planning a facility.Methods: This prospective cross sectional observational study was carried out over a period of one year at the Dialysis unit of a tertiary care, super specialty hospital in North India with the objective to establish that minor structural changes can enhance customer delight which includes patients and their attendants of a chronic disease patient population visiting a health care facility and satisfaction of the staff of the facility. The tool used was a structured 5 point Likert scaled questionnaire including unstructured interviews. These were held with 200 patients availing treatment in the old and new dialysis unit each and who have at least had three dialysis treatments within 6 months in the both the units. Also, for staff satisfaction, 25 staff working for at least one month in the old unit and new unit each. Data was analysed using SPSS 17.0 software.Results: Good design and quality of care were regarded important for patient experience. For patients, overall functioning and efficiency of the processes in the facility dependent on the design of the building was most important. Just over half of all surveyed patients felt that design impacted their relationship with their doctor and the quality of the care received. For attendants, waiting area including billing facility fetched the highest parameter for satisfaction. For staff the importance of access to support services, safety and provision of basic facilities resonated with the patient views presented above. Privacy, confidentiality and patient safety through careful design of waiting room, reception and consulting room were high staff priorities. Design that facilitated communication between team members also emerged as an important area although the change in design did not make much difference in emotional wellbeing and work life balance of the staff.Conclusions: This study did not yield sufficient data to confirm or refute either concept, though clearly this merit further investigation. Some unexpected findings were reported. Specifically, the survey data rated privacy and the availability of comfortable physical conditions as the highest priority for both staff and patients.

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