scholarly journals Assessment of emergency trolley drugs in a children’s hospital. Before and after study on an educational intervention

2020 ◽  
Vol 118 (4) ◽  
2007 ◽  
Vol 35 (4) ◽  
pp. 550-557 ◽  
Author(s):  
M. Lethbridge ◽  
A. Bouckley ◽  
N. A. Chambers

We conducted a prospective observational study of sevoflurane use over a four-week period at our tertiary referral children's hospital. Sevoflurane vaporisers were weighed before and after all general anaesthesia sessions and anaesthesia time intervals recorded. Midway through the audit, the initial findings were presented to the department with a brief reminder of ways to reduce sevoflurane use. These included recommendations for fresh gas flows and use of alternative agents during maintenance. Sevoflurane use then continued to be audited over a further two-week period. Anaesthesia in induction rooms accounted for 60% of total sevoflurane use but involved only 15% of total general anaesthetic time. Thus sevoflurane was used eight times faster in the induction rooms when compared to operating theatres. There was a 53% reduction in the rate of use of sevoflurane after the educational intervention, with an 87% reduction in in-theatre use and a 31% reduction in induction room use. This represents a potential saving of $108, 120 per annum in our institution. Workloads before and after the educational intervention were comparable. A more complete cost benefit analysis of this initiative would include the costs of alternative agents and any clinical disadvantages incurred and would be seen in the context of the overall health budget. This was beyond the scope of this project. Clinicians can be relatively complacent about financial accountability. In this study, a simple educational reminder halved sevoflurane use in the short term. This study suggests that specific reminders or recommendations about anaesthetic technique in the induction rooms may be indicated.


2013 ◽  
Vol 5 (1) ◽  
pp. 150-153 ◽  
Author(s):  
Erin E. Shaughnessy ◽  
Kimberly Ginsbach ◽  
Nicole Groeschl ◽  
Dawn Bragg ◽  
Michael Weisgerber

Abstract Background The Accreditation Council for Graduate Medical Education requires residency programs to ensure safe patient handovers and to document resident competency in handover communication, yet there are few evidence-based curricula teaching resident handover skills. Objective We assessed the immediate and sustained impact of a brief educational intervention on pediatrics intern handover skills. Methods Interns at a freestanding children's hospital participated in an intervention that included a 1-hour educational workshop on components of high-quality handovers, as well as implementation of a standardized handover format. The format, SAFETIPS, includes patient information, current diagnosis and assessment, patient acuity, a focused plan, a baseline exam, a to-do list, anticipatory guidance, and potential pointers and pitfalls. Important communication behaviors, such as paraphrasing key information, were addressed. Quality of intern handovers was evaluated using a simulated encounter 2 weeks before, 2 weeks after, and 7 months after the workshop. Two trained, blinded, independent observers scored the videotaped encounters. Results All 27 interns rotating at the Children's Hospital consented to participate in the study, and 20 attended the workshop. We included all participant data in the analysis, regardless of workshop attendance. Following the intervention, intern reporting of patient acuity improved from 13% to 92% (P < .001), and gains were maintained 7 months later. Rates of key communication behaviors, such as paraphrasing critical information, did not improve. Conclusions A brief educational workshop promoting standardized handovers improved the inclusion of essential information during intern handovers, and these improvements were sustained over time. The intervention did not improve key communication behaviors.


2014 ◽  
Vol 51 (7) ◽  
pp. 974-982 ◽  
Author(s):  
Anne P.F. Wand ◽  
William Thoo ◽  
Hayley Sciuriaga ◽  
Vicky Ting ◽  
Janett Baker ◽  
...  

2020 ◽  
pp. 1-3
Author(s):  
Juan L Segura Masís ◽  
◽  
Rodrigo Masís Mejías ◽  
Katherine Alfaro Navas ◽  
Santiago Rodríguez Picado ◽  
...  

Introduction: Refractory epilepsy can be defined as a failure of adequate trials of antiepileptic drug programs tolerated and appropriately chosen and used (either as monotherapy or in combination) to achieve sustained freedom from seizures. Surgical procedures for the control of epileptic seizures have spread throughout the world, however, large medical centers have mainly focused on studying and analyzing the clinical results of their surgical interventions. For this reason, this study aims to analyze the cost of pre and post-surgical anticonvulsant medications in patients. Objective: To analyze the relationship between preoperative cost / postoperative cost of antiepileptic drugs in patients undergoing hemispherectomy or temporary lobectomy at the National Children’s Hospital (Hospital Nacional de Niños-HNN). Materials and methods: This study is a retrospective, descriptive, quantitative and longitudinal type of a series of patients who were operated in the Epilepsy Monitoring and Surgery Unit (UMCE) of Costa Rica, between November 2000 and December 2018. Information on the history of medications is obtained from patients before and after having undergone hemispherectomy or temporal lobectomy to assess whether or not there is an economic saving in this aspect when comparing both periods of time. Results: 69 patients have undergone hemispherectomy and temporal lobectomy since the creation of the UMCE in November 2000. Of these, 18 (26%) underwent hemispherectomy and 51 (74%) underwent temporary lobectomy. A sample of 31 patients (45%) were obtained, which met the inclusion criteria. The average age of initiation of treatment at the HNN was 5.5 years old (66 months) and the average age at which they underwent surgery was 10.8 years old (130 months). There was one patient in the sample who received 9 anticonvulsant medications before undergoing the surgical procedure and the average number of medications used pre-surgically was 4.45 anticovulsivants per patient. The average postoperative medication was 2.35 anticonvulsivants per patient. The average monthly preoperative cost was $50.17, while the postoperative period was $31.26, with a difference of $18.91. A total of 9 patients in the sample increased the monthly postoperative cost. The total savings per month in the patients included in the sample was $586.36 and extrapolated to the population of 69 patients resulting in a saving of $1,305.14 per month. The projection according to the life expectancy of the patients in the sample translates into a saving of $409,188.59 while the projection to the 69 patients would result in a saving of $910,774.60 for the Caja Costarricense del Seguro Social (CCSS - Costa Rican Social Security Fund). Discussion: The effectiveness of these two surgeries in suitably selected patients is reflected in the economic savings represented by antiepileptic drugs administered after these surgical procedures. Conclusion: we consider that in this center the patients who have been operated have meant a saving for the Caja Costarricense del Seguro Social (CCSS) since they have diminished or completely eliminated the anti-epileptic medical treatment


1976 ◽  
Vol 43 (2) ◽  
pp. 60-64 ◽  
Author(s):  
Alice Lehrer

This article describes a pilot project in which eleven out-patients of the Occupational Therapy Department at the Montreal Children's Hospital were integrated into a summer day camp of a local YMCA. The objectives of this program are outlined, as well as the actual description of the camp program. An evaluation of the project examines the results of a questionnaire administered to the subjects' parents before and after the camp experience as well as a discussion of some additional advantages and disadvantages observed in the program. It appears that there are many indications for screening and treating children in the community, and that providing occupational therapy services to children in their natural milieu may be of significant benefit to the child. It is suggested that the integration of occupational therapy in the community be carried out permanently and extensively and that such programs deserve further study.


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