Search PubMed⌕ Search

Biomedical subjects

D Taylor

Publications and source records attributed to D Taylor.

639 records · Page 36Linked to original sources
PubMedDate not supplied

Direct fast track admission to a coronary care unit.

An audit of thrombolytic therapy for acute myocardial infarction (AMI) in 1992-93 showed that door to needle time had a median delay of 100 min. After discussion, we devised a new 'fast track' procedure. General practitioners (GPs) were given minimum criteria for diagnosing probable AMI and advised how to admit patients directly to the coronary care unit (CCU) after discussion with a senior CCU nurse. The hospital admitted 180 patients with MI between 1 July 1993 and 30 June 1994, 96 of whom received thrombolysis. Of the 11 admitted by the fast track procedure, eight received thrombolysis (median delay, 13.5 min; range, 5-30 min; p < 0.05 when compared with non-fast track patients). Four other patients were fast tracked to the CCU from other medical wards (time to thrombolysis, 6-12 min). In the following year to 30 June 1995 there were 158 admissions with MI, of whom 85 (54%) received thrombolysis. Four patients were admitted by the fast track procedure. Although the fast track procedure shortened the time to thrombolysis, the service was underused. A postal audit of local practices showed that 18% of GPs were still unaware of the service, in spite of newsletters, postgraduate meetings and direct contact. Most GPs (90%) said they would use the service in the future, but 25% stated later that they would not use it. Twenty per cent of non-fast track AMI patients were admitted by deputising doctors.

Adult↗
PubMedDate not supplied

Hospital use by pediatric patients: implications for change.

INTRODUCTION: We conducted an analysis of population-based records of hospitalizations for all children 1-12 years old in California in order to provide detailed descriptive diagnostic information on pediatric hospitalizations and to analyze differences in hospital use by population group. METHODS: We analyzed 1992 computerized hospital discharge data for all children ages 1-5 years (n = 76,611) and 6-12 years (n = 54,827) in California acute care hospitals. We looked at the major diagnoses resulting in hospitalization and the total cost and total length of hospital stay by diagnosis. Relative risks for hospitalization by race and gender were calculated with 95% confidence intervals. RESULTS: Discharges among children ages 1-5 years accounted for $746 million in hospital charges and 319,059 days of hospitalization while discharges among children ages 6-12 years accounted for $580 million and 310,912 hospital days. Asthma, injuries, pneumonia, gastroenteritis, and congenital disease accounted for 46% of hospitalizations in children between 1 and 5 years old. Injury, appendicitis, asthma, mental illness, and pneumonia accounted for 45% of hospitalizations in those between 6 and 12. The risk of hospitalization varied significantly by gender and race. CONCLUSIONS: Many pediatric hospitalizations are preventable, and further efforts are needed to address this problem through improved access to primary care and education. Of particular significance are the racial variations in risk of hospitalization due to asthma and mental illness.

Asthma↗