Protecting blinded trials in electronic hospital systems

Abstract Introduction Operative notes play a valuable role in ensuring that surgical patients receive consistent and adequate care. There are many inherent difficulties affecting their quality. We performed a QI project to improve surgical operative notes at our centre. Method A questionnaire assessing subjective quality of operative notes was sent to all foundation doctors delivering post-operative care. Compliance to each inclusion recommendation in the RCS guidelines was analysed. A standardised template for operative notes was incorporated into the hospital’s electronic records system, compliance was then reassessed. Results Questionnaire responses (16) were better for typed vs hand-written notes in all domains: ease of accessing notes, following intra-operative steps, following post-operative plans and frequency of asking for additional information regarding plans. After implementation of the template, mean compliance across 19 RCS parameters improved from 69% (55 operations) to 89% (46 operations). Number of parameters with 100% compliance improved from 2/19 to 8/19. Compliance increased in 14/19 parameters, there was no change in 2/19 (already 100%) and a reduction was seen in 3/19. Conclusions Results from our analysis and questionnaire showed that typed notes were favourable when compared to hand-written. The introduction of a standardised electronic template, without investment in new software, improved compliance to RCS guidelines.

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Classifications of psychologists in state mental hospital systems revisited

PsycEXTRA Dataset ◽

10.1037/e510812009-001 ◽

1964 ◽

Author(s):

Francis Hardesty ◽

Jacob Silverberg

Keyword(s):

Mental Hospital ◽

State Mental Hospital ◽

Hospital Systems ◽

State Mental

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“The talking bit of medicine, that’s the most important bit”: doctors and Aboriginal interpreters collaborate to transform culturally competent hospital care

International Journal for Equity in Health ◽

10.1186/s12939-021-01507-1 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Vicki Kerrigan ◽

Stuart Yiwarr McGrath ◽

Sandawana William Majoni ◽

Michelle Walker ◽

Mandy Ahmat ◽

...

Keyword(s):

Scale Up ◽

Aboriginal Peoples ◽

Culturally Competent ◽

Participatory Action ◽

Work Routines ◽

Hospital Systems ◽

Interpreter Service ◽

Field Notes ◽

Ward Rounds ◽

Inductive Thematic Analysis

Abstract Background In hospitals globally, patient centred communication is difficult to practice, and interpreters are underused. Low uptake of interpreters is commonly attributed to limited interpreter availability, time constraints and that interpreter-medicated communication in healthcare is an aberration. In Australia’s Northern Territory at Royal Darwin Hospital, it is estimated around 50% of Aboriginal patients would benefit from an interpreter, yet approximately 17% get access. Recognising this contributes to a culturally unsafe system, Royal Darwin Hospital and the NT Aboriginal Interpreter Service embedded interpreters in a renal team during medical ward rounds for 4 weeks in 2019. This paper explores the attitudinal and behavioural changes that occurred amongst non-Indigenous doctors and Aboriginal language interpreters during the pilot. Methods This pilot was part of a larger Participatory Action Research study examining strategies to achieve culturally safe communication at Royal Darwin Hospital. Two Yolŋu and two Tiwi language interpreters were embedded in a team of renal doctors. Data sources included interviews with doctors, interpreters, and an interpreter trainer; reflective journals by doctors; and researcher field notes. Inductive thematic analysis, guided by critical theory, was conducted. Results Before the pilot, frustrated doctors unable to communicate effectively with Aboriginal language speaking patients acknowledged their personal limitations and criticised hospital systems that prioritized perceived efficiency over interpreter access. During the pilot, knowledge of Aboriginal cultures improved and doctors adapted their work routines including lengthening the duration of bed side consults. Furthermore, attitudes towards culturally safe communication in the hospital changed: doctors recognised the limitations of clinically focussed communication and began prioritising patient needs and interpreters who previously felt unwelcome within the hospital reported feeling valued as skilled professionals. Despite these benefits, resistance to interpreter use remained amongst some members of the multi-disciplinary team. Conclusions Embedding Aboriginal interpreters in a hospital renal team which services predominantly Aboriginal peoples resulted in the delivery of culturally competent care. By working with interpreters, non-Indigenous doctors were prompted to reflect on their attitudes which deepened their critical consciousness resulting in behaviour change. Scale up of learnings from this pilot to broader implementation in the health service is the current focus of ongoing implementation research.

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The impact of an electronic hospital system on therapeutic drug monitoring

Journal of Clinical Pharmacy and Therapeutics ◽

10.1111/jcpt.13497 ◽

2021 ◽

Author(s):

Paul Firman ◽

Karen Whitfield ◽

Ken‐Soon Tan ◽

Alexandra Clavarino ◽

Karen Hay

Keyword(s):

Therapeutic Drug Monitoring ◽

Drug Monitoring ◽

Therapeutic Drug ◽

Hospital System ◽

The Impact ◽

Electronic Hospital

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Time trends in hospital discharges in patients aged 85 years and older in Spain: data from the Spanish National Discharge Database (2000–2015)

BMC Geriatrics ◽

10.1186/s12877-021-02335-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sergio Palacios-Fernandez ◽

Mario Salcedo ◽

Gregorio Gonzalez-Alcaide ◽

Jose-Manuel Ramos-Rincon

Keyword(s):

Length Of Stay ◽

Hospital Admission ◽

Age Groups ◽

Percentage Increase ◽

Very Elderly ◽

Hospital Discharges ◽

Data Set ◽

Common Causes ◽

Discharged Patients ◽

Hospital Systems

Abstract Background The aging population is an increasing concern in Western hospital systems. The aim of this study was to describe the main characteristics and hospitalization patterns in inpatients aged 85 years or more in Spain from 2000 to 2015. Methods Retrospective observational study analyzing data from the minimum basic data set, an administrative registry recording each hospital discharge in Spain since 1997. We collected administrative, economic and clinical data for all discharges between 2000 and 2015 in patients aged 85 years and older, reporting results in three age groups and four time periods to assess differences and compare trends. Results There were 4,387,326 discharges in very elderly patients in Spain from 2000 to 2015, representing 5.32% of total discharges in 2000–2003 and 10.42% in 2012–2015. The pace of growth was faster in older age groups, with an annual percentage increase of 6% in patients aged 85–89 years, 7.79% in those aged 90–94 years, and 8.06% in those aged 95 and older. The proportion of men also rose (37.30 to 39.70%, p < 0.001). The proportion of patients that died during hospital admission decreased from 14.64% in 2000–2003 to 13.83% in 2012–2015 (p < 0.001), and mean length of stay from 9.98 days in 2000–2003 to 8.34 days in 2012–2015. Some of the most frequent primary diagnoses became even more frequent relative to the total number of primary diagnoses, such as heart failure (7.84 to 10.62%), pneumonia (6.36 to 7.36%), other respiratory diseases (3.87 to 8.49%) or other alterations of urinary tract (3.08 to 5.20%). However, there was a relative decrease in the proportion of femoral neck fractures (8.07 to 6.77%), neoplasms (7.65 to 7.34%), ischemic encephalopathy (6.97 to 5.85%), COPD (4.23 to 3.15%), ischemic cardiomyopathy (4.20 to 8.49%) and cholelithiasis (3.07 to 3.28%). Conclusions Discharges in the very elderly population are increasing in both relative and absolute terms in Spanish hospitals. Within this group, discharged patients are getting older and more frequently male. The mean length of stay and the proportion of patients that died during hospital admission are decreasing. Acute-on-chronic organ diseases, neoplasms, acute cardiovascular diseases, and infections are the most common causes of discharge.

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The Effects of Production Performance Model and Competitive Environment of Hospital Systems

Applied Mechanics and Materials ◽

10.4028/www.scientific.net/amm.300-301.1623 ◽

2013 ◽

Vol 300-301 ◽

pp. 1623-1627

Author(s):

Ching Kuo Wei

Keyword(s):

Performance Model ◽

Production Performance ◽

Competitive Environment ◽

Data Envelopment ◽

Hospital System ◽

Department Of Health ◽

Competitive Environments ◽

Significant Difference ◽

Efficiency Performance ◽

Hospital Systems

This study investigated the efficiency performance of the production technology of the Department of Health (DOH)-affiliated hospital system in Taiwan in different competitive environments. This study used Data Envelopment Analysis (DEA) to analyze a total of 396 hospitals of different systems in Taiwan. The results indicated that, in terms of the internal competitive environment, the production performance of hospital Q was the best, while that of hospital N was the worst. This study also analyzed the production performance and scale of DOH-affiliated hospitals and provided hospitals with a direction for scale development. Finally, this study proposed suggestions on improvement direction for hospitals with poor production performance. As for external competitive environment, there is no significant difference in the average efficiency among various hospital systems. However, there are a lot to be improved in DOH-affiliated hospitals, especially in the aspect of technology efficiency. The improvement of technology efficiency should be more beneficial to the overall efficiency.

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Abstract 12: Feasibility of Monitoring Covid-19 Related Stroke Patients Across a 14 Hospital Stroke System of Care

Stroke ◽

10.1161/str.52.suppl_1.12 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Howard J Rho ◽

Navdeep S Sangha

Keyword(s):

Stroke Care ◽

Stroke Patients ◽

Specific Data ◽

Related Data ◽

Disease States ◽

Hospital Systems ◽

Pandemic Response ◽

Relationship Of ◽

The Relationship ◽

Existing Data

Background: Identifying and tracking COVID-19 related data has been crucial to the pandemic response. Most hospital systems have created internal tracking databases specific to COVID-19 but separated from other disease specific data pools. Traditional methods for tracking and trending novel and specific data such as COVID-19 related strokes may require personnel with highly technical skills to abstract the data. We aimed to create a COVID-19 stroke dashboard which would easily auto-abstract and update data. Methods: A simple monitoring system was designed using PowerBI™ and Microsoft Suite™ products that model existing data sources without using other IT resources. Existing data queries from various sources were modeled into one report and the resulting data model was used to track and trend incidence of COVID-19 and its relationship to stroke care throughout a 14- hospital stroke system. Results: The report allowed region-wide identification and evaluation of several metrics, including: volume of code strokes, the volume of patients who had a stroke within two weeks before or after testing positive for COVID-19, the initial NIHSS, if alteplase was administered, reason for no alteplase administration, delay in alteplase administration and if related to COVID-19 and the relationship of COVID-19 cases to the volume of code strokes. It was found that the volume of code strokes significantly decreased during the time of the pandemic and was inversely related to the volume of COVID-19 positive cases being reported in a county. The tool also found that COVID-19 positive stroke patients increased as the overall COVID-19 hospital volume increased. Conclusion: Assessing the relationships between a novel disease and other disease states may lead to changes in hospital workflows and practices resulting into improved patient outcomes.

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Development and localisation of casemix applications for inpatient hospital activity in EU member states

Australian Health Review ◽

10.1071/ah990069 ◽

1999 ◽

Vol 22 (2) ◽

pp. 69 ◽

Cited By ~ 3

Author(s):

Miriam M Wiley

Keyword(s):

European Union ◽

Policy Development ◽

Union Member ◽

Research Evidence ◽

Acute Hospital ◽

Member States ◽

Eu Member States ◽

Cultural Boundaries ◽

Hospital Systems ◽

European Union Member States

The successful infiltration of casemix techniques across geographical, systemic and cultural boundaries provides an interesting and timely example of the translation of research evidence into health policy development. This paper explores the specifics of this policy development by reviewing the application of casemix techniques within the acute hospital systems of European Union member states. The fact that experimentation with or application of casemix measures can be reported for the majority of European Union member states would suggest that the deployment of these measures can be expected to continue to expand within these health systems into the new millennium.

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Organizing hospitals into networks: a hierarchical and multiservice model to define location, supply and referrals in planned hospital systems

OR Spectrum ◽

10.1007/s00291-011-0272-1 ◽

2011 ◽

Vol 34 (2) ◽

pp. 319-348 ◽

Cited By ~ 38

Author(s):

Ana Maria Mestre ◽

Mónica Duarte Oliveira ◽

Ana Barbosa-Póvoa

Keyword(s):

Hospital Systems

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Predicting Onset of Dementia Using Clinical Notes and Machine Learning: Case-Control Study (Preprint)

10.2196/preprints.17819 ◽

2020 ◽

Author(s):

Christopher A Hane ◽

Vijay S Nori ◽

William H Crown ◽

Darshak M Sanghavi ◽

Paul Bleicher

Keyword(s):

Machine Learning ◽

Language Processing ◽

Disease Onset ◽

Area Under The Curve ◽

Learning Models ◽

Term Care ◽

Clinical Notes ◽

Patients At Risk ◽

Hospital Systems ◽

Machine Learning Models

BACKGROUND Clinical trials need efficient tools to assist in recruiting patients at risk of Alzheimer disease and related dementias (ADRD). Early detection can also assist patients with financial planning for long-term care. Clinical notes are an important, underutilized source of information in machine learning models because of the cost of collection and complexity of analysis. OBJECTIVE This study aimed to investigate the use of deidentified clinical notes from multiple hospital systems collected over 10 years to augment retrospective machine learning models of the risk of developing ADRD. METHODS We used 2 years of data to predict the future outcome of ADRD onset. Clinical notes are provided in a deidentified format with specific terms and sentiments. Terms in clinical notes are embedded into a 100-dimensional vector space to identify clusters of related terms and abbreviations that differ across hospital systems and individual clinicians. RESULTS When using clinical notes, the area under the curve (AUC) improved from 0.85 to 0.94, and positive predictive value (PPV) increased from 45.07% (25,245/56,018) to 68.32% (14,153/20,717) in the model at disease onset. Models with clinical notes improved in both AUC and PPV in years 3-6 when notes’ volume was largest; results are mixed in years 7 and 8 with the smallest cohorts. CONCLUSIONS Although clinical notes helped in the short term, the presence of ADRD symptomatic terms years earlier than onset adds evidence to other studies that clinicians undercode diagnoses of ADRD. De-identified clinical notes increase the accuracy of risk models. Clinical notes collected across multiple hospital systems via natural language processing can be merged using postprocessing techniques to aid model accuracy.

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