This paper discusses the opportunity for hospital management to make greater use of comparative data on physician productivity. We report findings from a study on utilization information provided to physicians in 19 US and British hospitals. Most doctors reported that they did not receive information comparing their own use of resources with that of their peers. However, our survey found that a significant majority of doctors want more information and find it useful; but, that hospital managers perceive doctors as being uninterested in such information. While there are wide variations between the two countries and between their hospitals in data collection and information systems, most hospitals surveyed could make better use of utilization information to influence physician practice patterns.

Efficiency↗

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Continuous infusion of insulin vs repeated S.C. injections in the treatment of diabetic ketoacidosis in children.

Thirty-two episodes of diabetic ketoacidosis in 30 children treated with conventional repeated s.c. injections of insulin every 4 h are compared with 18 episodes in 14 children treated with continuous i.v. insulin infusion. Fluid therapy, bicarbonate and potassium supplementation were essentially the same for both groups. Recovery as reflected in serum glucose, bicarbonate and the rate of rehydration, was smoother and more rapid in the children receiving continuous i.v. insulin, though the difference just failed to attain statistical significance in this small series of cases. There was, however, a marked difference in insulin administered (0.58 U/kg +/- 0.05 SEM in the children treated with continuous i.v. insulin infusion vs 2.54 +/- 0.27 SEM in the children treated with repeated s.c. injections). Hypoglycemia was noted in 11 and hypokalemia in 10 children on conventional insulin therapy given every 4 h s.c. In contrast, there was no hypoglycemia and only one case of hypokalemia with the i.v. insulin infusion.

Adolescent↗