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PubMed1999

[Management of mycobacteriosis in general hospital without isolation ward for tuberculosis patients. 3. Current status of tuberculosis patient care in university hospitals and general hospitals in Japan].

A recent epidemiological survey has revealed that the incidence of Mycobacterium tuberculosis (TB) patients in Japan has just increased again after four decades of decline. In fact, recently there have been numerous reports of TB outbreaks in health-care facilities. Although our medical school hospital does not have TB isolation rooms, we have to take care of more than a few TB patients, most of whom have been transferred from primary care clinics. Although, some of these TB patients have highly infectious (sputum smear positive), most of them have not been diagnosed as having highly infectious TB, and therefore, some of their patients ultimately have to be retransferred to a TB hospital. This indicates that most physicians in primary care clinics have little knowledge about TB. This may be partly because of lack of training regarding TB during their medical student days and residencies. To elucidate current TB patient care status in university hospitals in Japan, a survey of physicians working in such hospitals was conducted from September 1997 to January 1998. The survey (questionnaire) revealed that the majority (76%) of these hospitals do not have TB isolation rooms. However, these hospitals have to take care of TB patients in their outpatient clinics and sometimes on their wards because the patients have serious complications that can not be treated in ordinary TB hospitals. The survey also showed that for this reason and from an educational point of view, the majority of the physicians (90%) working in these hospitals thought that university hospitals should have isolation rooms for such patients. Another questionnaire revealed that few physicians and nurses in university hospitals have sufficient experiences in taking care of TB patients. This situation may have been responsible for producing physicians with little knowledge about TB. Recent scientific advances have made it possible to construct TB isolation rooms in ordinary wards by means of separate ventilation systems. Although combatting TB requires a variety of strategies, appropriate education for both medical students and residents using isolation rooms in university hospitals may be an effective means of preventing spread of TB, and this approach may also increase awareness concerning the prevention of TB outbreaks in hospitals and health-care facilities.

Hospitals, General↗
PubMed2000

[Smoking by an Israeli general hospital staff, and attitude to smoking in hospitals. Are we in Israel ready to institute "smoke-free hospitals"?].

Smoking within hospitals is common in general hospitals in Israel. It has a strong negative educational impact, has a negative image and curing its ill effects help keep our hospitals busy. An anonymous questionnaire was answered by 128 members of our hospital staff (28%). Their distribution, according to occupation and sex was representative of the rest of our hospital staff. 19% of our workers are smokers, a much lower proportion than in our general adult population. The proportion was highest among maintenance (40%) and sanitary-help staff (36%). 23% of nurses and 15% of physicians were smokers. This situation is better than that among Italian or Japanese medical staff, but much worse than among North American medical staff. 75% of our workers who smoke declared that they smoke outside the room in which they work. 66% and 72% of the staff believe that hospital workers and visitors, respectively, should smoke outside hospital buildings. Only 19% of all workers do not believe that a "smoke-free hospital" is attainable. 34% believe that a "smoke-free hospital" is achievable, and 47% said that it is perhaps achievable. 86% of all the workers, and 41% of the smokers, expect the hospital director to implement an effective policy of enforcing the law limiting smoking within hospitals (and other public buildings) in Israel. 60% are willing to contribute actively to this effort. We believe these results strongly suggest that the time is ripe for implementation of the "smoke-free hospital" in Israel. This requires a strong and effective central policy, like that in the USA. We suggest measures that the Israel Ministry of Health take measures to successfully implement this policy.

Adult↗
PubMed2000

[Early days of the Ocean Road Hospital in Dar es Salaam: from mission hospital to government hospital].

On 1 October 1997 Ocean Road Hospital in Daressalam commemorated one hundred years of its existence. As early as 1888 a provisional hospital had been set up in Zanzibar by the German Lutheran Church to serve the needs of the Germans living and working on the East African coast. But when the British established their protectorate over Zanzibar in 1890, the hospital was moved to Dar es Salaam. As cooperation between Mission hospital and Government authorities proved difficult, the German colonial administration was determined to build an hospital of its own. Lack of funds delayed the construction of the building which had to be built on a more modest scale than originally planned. But when the hospital was inaugurated in October 1897, people were impressed both by its functional usefulness and aesthetic attraction. The history of the German Government Hospital reflects the political context of the time as well as the progress of medicine in combatting endemic diseases. While patients were often segregated by race--the Government Hospital in Daressalam almost exclusively reserved for Europeans--all were benefitting from the results of medical science. For Robert Koch the hospital (and its laboratory) served as basis for his research in the field of malaria, black water fever, sleeping sickness, and relapsing fever. It was from Africa that the embarked on his journey to Stockholm to receive the Nobel Prize in December 1905. During the First World War Ocean Road Hospital, as it was called from now on, was taken over by the British. Since independence, the Tanzanians are in charge. It is presently the only tumor hospital of the country, closely cooperating with the German Cancer Research Center (DKFZ) in Heidelberg. Restoration of Ocean Road Hospital, completed at the beginning of this year, was made possible by a grant of the Federal Republic of Germany.

Endemic Diseases↗
PubMed1986

Are public hospitals in New York City inferior to voluntary, nonprofit hospitals? A study of JCAH hospital surveys.

All 60 non-profit, acute-care hospitals in New York City were grouped into three classes: publicly supported hospitals (HHCs), voluntary hospitals under 400 beds (CHs), and voluntary hospitals over 400 beds (SHs). 11 functional areas listed in Joint Commission on Accreditation of Hospitals 1980-1982 surveys were analyzed to compare recommendations for improving cited deficiencies. The survey findings showed that HHCs had a mean of 37.8 recommendations per hospital compared to 42.7 for CHs and 46.9 for SHs. The 11 functions were aggregated into three major components: safety, support, and direct medical services. CHs had fewer safety mean recommendations per hospital (18.7) than SHs (22.2) and HHCs (22.2), but on support and direct medical service components HHCs had fewer recommendations than the other two hospital groups. HHCs had fewer recommendations on nine of 11 functions compared to the other hospitals. Based on these data, HHCs do not appear inferior to either class of voluntary hospitals.

Accreditation↗
PubMed2007

Hospital stays, hospital charges, and in-hospital deaths among infants with selected birth defects--United States, 2003.

Birth defects (BDs) are conditions that 1) result from a malformation, deformation, or disruption in one or more parts of the body; 2) are present at birth; and 3) have a serious, adverse effect on health, development, or functional ability. BDs are leading causes of pediatric hospitalizations, medical expenditures, and infant mortality. To estimate national hospital charges and rates of in-hospital deaths for a greater number of specific BDs than estimated in previous reports, investigators at the University of Arkansas for Medical Sciences and CDC used the Healthcare Cost and Utilization Project 2003 Kids' Inpatient Database (KID), developed and distributed by the Agency for Healthcare Research and Quality. KID is a 10% sample of hospital discharges after uncomplicated births and an 80% sample of all other pediatric discharges from 36 participating states. Data are weighted to represent all pediatric hospitalizations in the United States. The investigators analyzed hospital stays during 2003 for newborn infants with any of 35 BDs. This report describes the results of that analysis, which indicated substantial variation among BDs regarding average length of stay, average hospital charge, and the incidence of in-hospital deaths. Average length of stay was greatest for infants with surgically repaired gastroschisis or omphalocele. Average hospital charges were highest for infants with hypoplastic left heart syndrome and common truncus arteriosus. Although anencephaly, trisomy 13, and trisomy 18 were associated with the highest rates of in-hospital death, the largest total numbers of deaths associated with neonatal hospitalizations occurred in infants with diaphragmatic hernia and renal agenesis. Further studies are needed to distinguish outcomes for infants with isolated and multiple defects and to assess longer-term outcomes.

Congenital Abnormalities↗
PubMed2003

[Authorization, institutional services, hospital-based practices and cooperation in the hospital--from the point of view of the hospital owners].

Structural changes in the financing of hospital-based health care in Germany make a revision of the currently existing strict separation between ambulatory and stationary patient care inevitable. The present monopolist situation of office-based physicians (organised in private practices without any legal or financial relation to a hospital) will be amended by the participation of hospitals and hospital-employed doctors in ambulatory services of a different kind. These may include the institutional authorization of hospitals to participate in ambulatory services, especially in the case of emergencies and first aid, and co-operations between doctors in private practices and hospitals. Such co-operations are now legally enabled to provide "integrated services", but still lacking acceptance by the parties involved in the health care services. Ambulatory medical care is an already huge and now rapidly growing market, whereas the classical hospital services represent a declining product. Therefore hospitals will have to act accordingly or they will even forfeit the opportunity to use the ambulatory care sector to improve the intensity of utilisation of their hospital beds. In addition, hospitals will have to accept that office-based doctors are their customers and have to be treated as such. The establishment of regional networks may be a solution to this problem. Integrated services can only be established if new ways of co-operation and knowledge transfer are introduced into this area step by step. The present article provides practical examples of co-operation models.

Germany↗
PubMed2005

Effectiveness of a hospital-wide selective screening programme for methicillin-resistant Staphylococcus aureus (MRSA) carriers at hospital admission to prevent hospital-acquired MRSA infections.

Screening of potential MRSA-positive patients at hospital admission is recommended in German and international guidelines. This policy has been shown to be effective in reducing the frequency of nosocomial MRSA transmissions in the event of an outbreak, but the influence of screening on reducing hospital-acquired MRSA infections in a hospital setting where MRSA is endemic is not yet well-documented. This study describes the effect of hospital-wide screening of defined risk groups in a 700-bed acute care hospital during a period of 19 months. In a cohort study with a 19-month control period, the frequencies of hospital-acquired MRSA infections were compared with and without screening. In the control period, there were 119 MRSA-positive patients, of whom 48 had a hospital-acquired MRSA infection. On the basis of this frequency, a predicted total of 73.2 hospital-acquired MRSA infections was calculated for the screening period, but only 52% of the expected number (38 hospital-acquired MRSA infections) were observed, i.e., 48% of the predicted number of hospital-acquired MRSA infections were prevented by the screening programme. The screening programme was performed with minimal effort and can therefore be recommended as an effective measure to help prevent hospital-acquired MRSA infections.

Aged↗
PubMed1980

Hospital and outpatient care for psychotic patients during the last three decades. Subsequent hospital and outpatient treatment of psychotic patients hospitalized for the first time in 1949--50, 1959--60 or 1969--70.

The study deals with the development in the extent of hospital treatment and trends concerning outpatient visits for psychotics in Turku hospitalized for the first time in 1949--50 (period of shock therapy), 1959--60 (period of neuroleptics) or 1969--70 (period of intensified outpatient treatment). The bed capacity for psychiatric patients increased in Turku in the 1950-s, but has declined slowly since then. The number of hospitalized cases nevertheless continued to rise up to the 1970's. The number of caretaking personnel in the outpatient sector has increased five-fold and the extent of outpatient visits 20-fold over the 25 years covered by the study. After the introduction of neuroleptics, first hospitalizations became shorter, as fewer and fewer patients remained in long-term hospital treatment. At the same time the annual extent of hospital treatment declined, whereas rehospitalizations became more frequent. Along with intensified outpatient treatment first hospitalizations became still shorter, but the total need for hospital treatment was not reduced. During intensified outpatient treatment, rehospitalization was rapid and, at first, frequent; subsequently rehospitalizations became less frequent compared to the period of neuroleptics. In the 1970's intensive outpatient treatment provided immediately after the first hospital stay appears to be most clearly associated with a reduction in the number of hospital treatment days of schizophrenics. In the case of psychoses of old age an increased extent of outpatient treatment did not lead to a decline in the need for hospital treatment.

Adolescent↗
PubMed2003

Acute pyelonephritis in US hospitals in 1997: hospitalization and in-hospital mortality.

PURPOSE: To describe the 1997 incidence of hospitalization for acute pyelonephritis in the US and the risk factors for in-hospital mortality associated with acute pyelonephritis. METHODS: Cases were defined as those with ICD9-CM codes corresponding to acute pyelonephritis in the 1997 Health Care Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS). Frequencies and calculations were weighted to produce either national or state estimates. Hospitalization rates were calculated using 1997 US Census Bureau population projections for the denominator. RESULTS: Females were almost five times as likely as males to be hospitalized for acute pyelonephritis (11.7/10,000 vs. 2.4/10,000), but males had higher mortality rates (16.5/1000 vs. 7.3/1000); 30% greater after adjustment. Hospitalization and in-hospital mortality rates increased with age, but not with diabetes. Mortality rates increased with number of procedures, diagnoses and having a major diagnostic category other than disorders of the kidney and urinary tract. Persons living in zip codes with lower median incomes were also at higher risk of mortality. There was little variation in mortality by hospital size, ownership, location or teaching status. CONCLUSION: In hospital mortality for pyelonephritis was associated with patient rather than hospital characteristics suggesting uniform application of standard care across hospitals and populations.

Acute Disease↗
PubMed2006

Surgical and anesthesiological procedures and patients outcome in a major teaching hospital, in a major non-teaching hospital and in a minor hospital.

AIM: This study was carried out to evaluate the outcome of patients in different hospitals with the aim to plan future structural and management changes. METHODS: All the anaesthesiological and surgical procedures were observed for a 2 weeks period in a major teaching hospital (A), in a major nonteaching hospital (B) and in a minor nonteaching hospital (C) in all the patients requiring anaesthesia. The main and the co-existing diseases and the surgical and anaesthesiological treatments they received were evaluated to determine the outcome. The ASA class, the duration of the procedure, the length of staying in hospital, the transfusions of blood or derivatives, the adverse events for each patient were also observed. RESULTS: The results showed that the patients admitted to the teaching hospital were classified in higher ASA risk classes and had surgery of longer duration, with a higher ratio of major surgery. The outcome was satisfactory in all the 3 hospitals, with a 2 days length of stay respectively in 30% (A and B) and 50% (C) of the patients. The rate of mortality was low: only 3 patients in hospital A and no patient in B and C died in a period of 2 days following surgery. Hospitals B and C showed a large use of modern techniques such as autologous blood transfusion and central and peripheral anaesthetic blocks, with a better cost-benefit ratio than the major teaching hospital. CONCLUSIONS: This study showed good results, but it should be repeated in a few years in order to evaluate any change and possible improvement in the management and outcome of the patients.

Adult↗
PubMed1990

Patterns and correlates of psychiatric hospitalization in a nationwide sample. II. Correlates of length of hospitalization and length of stay out of hospital.

A nationwide random sample of psychiatric patients (n = 832) admitted for hospitalization in Israel in 1980 was followed up until the end of 1984. A multivariate analysis was performed, where the dependent variables were: the cumulative length of all hospitalizations, the mean duration of hospitalization and the mean length of stay out of hospital. The independent variables were: age, sex, marital status, ethnic origin, diagnosis, and various indices of previous hospitalizations. For patients whose hospitalization in 1980 (index hospitalization) was the first in their life, older age and male gender predicted a low probability of readmission, and the diagnosis of schizophrenia a long cumulative stay. For patients whose index hospitalization was not the first in their life, the main variables predictive of long cumulative stay were: old age, being single, long duration and high frequency of previous hospitalizations. Patients tended to maintain the same relative length of inpatient stay and the same frequency of readmission from the beginning of their hospitalization history.

Adolescent↗
PubMed1992

Prescribing at the hospital-general practice interface. II: Impact of hospital outpatient dispensing policies in England on general practitioners and hospital consultants.

OBJECTIVE: To assess the impact on general practitioners and hospital consultants of hospital outpatient dispensing policies in England. DESIGN: Postal questionnaire and telephone interview survey of general practitioners and hospital consultants in January 1991. SETTING: 94 selected major acute hospitals in England. PARTICIPANTS: 20 general practitioners in the vicinity of each of 94 selected hospitals and eight consultants from each, selected by chief pharmacists. MAIN OUTCOME MEASURES: Proportions of general practitioners unable to assume responsibility for specialist drugs and of consultants wishing to retain responsibility; association between dispensing restrictions and the frequency of general practitioners being asked to prescribe hospital initiated treatments. RESULTS: Completed questionnaires were obtained from 1207 (64%) of 1887 general practitioners and 457 (63%) of 729 consultants. 570 (46%) general practitioners felt unable to take responsibility for certain treatments, principally because of difficulty in detecting side effects (367, 30%), uncertainty about explaining treatment to patients (332, 28%), and difficulty monitoring dosage (294, 24%). Among consultants 328 (72%) wished to retain responsibility, principally because of specialist need for monitoring (93, 20%), urgent need to commence treatment (64, 14%), and specialist need to initiate or stabilise treatment (63, 14%). The more restricted the drug supply to outpatients, the more frequently consultants asked general practitioners to prescribe (p less than 0.01) and complete a short course of treatment initiated by the hospital (p less than 0.001). CONCLUSIONS: Restrictive hospital outpatient dispensing shifts clinical responsibility on to general practitioners. Hospital doctors should be able to retain responsibility for prescribing when the general practitioner is unfamiliar with the drug or there is a specialist need to initiate, stabilise, or monitor treatment.

Attitude of Health Personnel↗
PubMed2006

[Predictors of hospital death and prolonged hospitalization in patients with cardiac failure in Chilean hospitals].

BACKGROUND: Heart failure (HF) is one of the most common causes for hospital admission. AIM: To evaluate clinical predictors of mortality and prolonged hospital stay among patients admitted for HF in Chilean hospitals. PATIENTS AND METHODS: Prospective registry of 14 centers. Patients admitted for HF in functional class III and IV were included. Epidemiological, clinical data, functional class, decompensation cause, electrocardiogram, echocardiogram, treatment and evolution were registered. The endpoint was hospital death and hospital stay greater than 10 days. RESULTS: Data from 646 patients (mean age 69+/-13 years, 56% men) was collected. The main etiologies of HF were hypertensive in 29.6%, ischemic in 27.1% and valvular in 20%. Mean hospital stay was 10+/-9 days and mortality was 5.6%. Independent predictors of death and prolonged hospital stay were serum sodium <130 mEq/L at admission (odds ratio (OR) 2.6, confidence interval (CI) = 1.2-5.9), serum albumin <3 g/dL (OR 3.2, CI= 1.42-7.2) and a history of hypertension (OR 1.98, CI = 1.1-3.85). The model predicted correctly the occurrence of the endpoint in 67% of cases. CONCLUSIONS: In patients admitted for worsening HF, low serum sodium, decreased serum albumin on admission and a history of hypertension increase the risk for in-hospital death and prolonged hospital stay.

Adolescent↗
PubMed1995

Comparison of unscheduled hospital admission following ambulatory operative laparoscopy at a teaching hospital and a community hospital.

The objective was to identify and compare causes of unscheduled admission following ambulatory major operative gynecologic laparoscopy in a university hospital and a community hospital setting. Each patient admitted on an unscheduled basis was compared with 2 patients who did not require admission. Twenty-seven variables were evaluated by univariate analysis. Significant factors (p < 0.5) were analyzed by multivariate stepwise logistic regression. Patients admitted at the university hospital were compared with patients at a community hospital. In a 7-year period, 43 patients at the University of Mississippi Medical Center and, in a 6-year period, 30 patients at Gilmore Memorial Hospital required unscheduled admission following ambulatory major operative gynecologic laparoscopy. Site-specific analysis was performed, and these groups also were combined for analysis. The only factor associated with admission by multivariate analysis was estimated operative blood loss. Postoperative emesis was the most common reason for unscheduled admission at both hospitals and occurred in 27 patients. An additional 17 patients were admitted because of the severity of postoperative pain. Operative blood loss seems to be associated with extensive operations. Furthermore, increased blood loss typically leads to a very conservative approach to the postoperative patient, whereas minimal blood loss allows patients to be managed in a routine fashion. Patients at the university hospital seem to be generally comparable to patients at a community hospital. Postoperative nausea and pain resulted in over one half of admissions. Successful therapy for nausea and pain may reduce unscheduled admissions.

Ambulatory Surgical Procedures↗
PubMed2002

Investigation of the correlation between inappropriate hospitalization and hospital stay rate: an application in medical clinics of a military hospital.

BACKGROUND: Medical services play a major role in hospital facilities. Along with the medical applications and diagnoses, physicians affect the hospital costs by 70% to 80%. Therefore, the hospital administrators should establish some systems that can modify the current application models of physicians. OBJECTIVE: This study aimed to investigate the appropriateness of hospitalization days and length of stay of the patients in 13 internal clinics in a military hospital. STUDY DESIGN: 5,205 patient days belonging to 416 patients were evaluated by Appropriateness Evaluation Protocol. Patients' data were retrospectively collected by using a "data collection form" through patients' files and then were evaluated by frequencies and percentage distributions. RESULTS: The unnecessary hospitalization rate and unnecessary stay rate were 4.8% and 15.75%, respectively. The highest unnecessary hospitalization rates were in nuclear medicine (50%). CONCLUSION: It was concluded that the inappropriate hospitalization rate and inappropriate stay rates were 4.8% and 15.75%, respectively.

Decision Making↗
PubMedDate not supplied

A multidisciplinary field hospital as a substitute for medical hospital care in the aftermath of an earthquake: the experience of the Israeli Defense Forces Field Hospital in Duzce, Turkey, 1999.

The damage created by an earthquake can overwhelm local health services, and damage to clinics and hospitals can render them useless. After an earthquake, even undamaged medical facilities cannot be used for a period of time if there is a risk of aftershocks and collapse. In such a situation, there may be calls for international health teams--but what constitutes the optimal medical aid a few days after the event? Does a military field hospital fill the "gap" in the local healthcare system? On 12 November 1999, a 7.2 magnitude earthquake struck Duzce, Turkey. All of the medical activities of the responding Israeli Defense Forces (IDF) mission team field hospital in Duzce, Turkey were recorded and evaluated. A total of 2,230 patient contacts occurred at the field hospital during the nine days it operated. Most of the patients who presented (90%) had non-traumatic medical, pediatric, or gynecological problems unrelated to the earthquake. The IDF hospital offered medical care provided by specialists, hospitalization, and surgical abilities, which Duzce's hospitals could not offer until two weeks after the earthquake. These results strengthen the importance of a multidisciplinary, versatile, field hospital as an aid to an earthquake-affected population during the first few weeks after an earthquake.

Disasters↗