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PubMed2006

The role of telemedicine and information technology in the redevelopment of medical systems: The case of Kosova.

The medical system of Kosova was largely destroyed in 1999 by the departing Serbian forces, leaving behind Albanian physicians systematically excluded from advanced medical services for a decade and medical facilities severely damaged in the course of departure in a region with an infrastructure fragmented over the years. The medical system of Kosova can be analyzed for the effectiveness of the many efforts following the disruption of medical care in the 1990s. In this paper, the application of telemedicine and information is recounted. The medical system of Kosova was offered the concept of the International Virtual E-Hospital and this model was used to support, supplement, and guide a massive program development that involved essentially every physician and medical personnel in the region. Currently, the Telemedicine Center of Kosova (TCK) is providing information resources for medical education programs within the Kosova's medical system as well as regional and international consultations and collaboration. Furthermore, it is developing the human resources that will lead and implement telemedicine programs in this region and making serious strides in the redevelopment of medical systems using information technology.

Developing Countries↗
PubMed2000

Trauma patient outcome in an army Deployable Medical Systems environment compared with a medical center.

William Beaumont Army Medical Center is the second busiest trauma center in the Army. Recent facility renovations there necessitated the use of a temporary field hospital to serve as the Emergency Department, which included the initial evaluation and resuscitation of trauma patients by the trauma team. Although designed for the battlefield, the use of field medical equipment during renovation of military medical facilities is not a new concept. The MUST (Medical Unit Self-contained Transportable) and DEPMEDS (Deployable Medical Systems) have been used successfully during fixed-facility renovations. Previously described functions included inpatient services, outpatient care, and operating room facilities. However, no published information directly compares the use of these temporary structures with standard fixed facilities in the initial management of trauma patients. Trauma patients often present with complex concerns, are highly resource intensive, and their survival is dependent on efficient, timely care. We compared several aspects of patient outcome in the DEPMEDS versus the medical center.

Adolescent↗
PubMed1984

Consultant evaluation of a hospital medication system: analysis of the existing system.

A consultant team's evaluation of a system for distributing and controlling medications in a large teaching hospital is described. Through interviews with key personnel from administration, pharmacy, nursing, and the medical staff, an interdisciplinary research group identified problems in the reliability and response times of the hospital's existing medication system. After assessing staff expectations regarding acceptable standards for medication errors and response times and their attitudes toward proposed changes in the medication system, medication-error rates were determined using a pharmacist-observer method. Observations during 34 five-hour periods on four nursing units were conducted over a 17-day period. Medication-error rates were calculated as the frequency of medication errors during the observation period divided by the total opportunities for error (OE), which were defined as doses ordered plus unauthorized doses given. Response times for processing "now," "stat," and routine orders were also determined using work-sampling methods. The total medication-error rate for the nursing units studied was 9% excluding wrong-time errors; more than a third of doses were given more than 30 minutes before or after their scheduled administration times. Response times for "now" and "stat" orders averaged about 23 minutes, in conformance with the desired standard of 30 minutes. However, processing of routine orders required an average of two hours and seven minutes, much of which was attributed to delays in the messenger service. The basic design of the existing unit dose medication system contributed to problems in the reliability and efficiency of the system.

Attitude of Health Personnel↗
PubMed2001

Preventing needlesticks in emergency medical system workers.

Emergency medical system (EMS) workers frequently use sharp devices in injury-prone circumstances that involve limited visibility, confined spaces, rapidly moving vehicles, and uncooperative victims. This study examined the efficacy of an automatic self-retracting lancet in reducing needlestick injuries and related direct and indirect costs. Subjects were 477 active-duty EMS workers. Counseling, laboratory testing (hepatitis B and C, hepatic function enzymes, and human immunodeficiency virus), antiviral prophylaxis, and immunizations were provided according to US Public Health Service guidelines. Baseline and biennial laboratory testing for hepatitis B and C and liver function enzymes were conducted. After the introduction of a spring-loaded automatic-retracting type glucometer lancet device, needlestick injuries decreased from 16 per 954 EMS worker-years to 2 per 477 EMS worker-years. The annualized cost of treatment declined from $8276 to $2068. The change to a self-retracting device decreased the number of needlestick injuries and was cost-effective with a minimal increase in device cost (annualized $366 per year).

Accidents, Occupational↗
PubMed1998

Understanding medical systems.

The prominence of physicians in highly interdependent medical systems confers tremendous power on them, individually and as a profession. With this power comes an ethical responsibility to be deeply concerned about medical systems. Examples of medical systems include the process of treating patients with diabetes; a hospital; the development and testing of new medical procedures; and a medical practice, including locations of care, billing, and collection of fees for medical care. The physician who is willing to learn about the nature of systems, how to control them, and how to improve them can significantly influence medical systems. Many persons in health care organizations identify strongly with their individual profession or department. Management structures, professional organizations, and methods of billing for services reinforce these divisions. This fragmented environment allows the structure of medical systems to evolve piecemeal from the various actions and points of view of physicians, nurses, administrators, patients, and payers. Improvement results from new structures that are purposefully designed. To achieve improvement, people must look beyond their own professional or organizational identities and see themselves as part of the larger system. Even a rudimentary understanding of the structures and dynamics of systems combined with clinical knowledge can equip a physician to collaborate with colleagues to diagnose faults of a system and design remedies. This paper explores the nature of medical systems and develops ideas their proper application to medicine and the activities of physicians.

Clinical Laboratory Techniques↗
PubMed1993

[Quality of care at a regional emergency medical system].

The Emergency Medical System (EMS) in the district of Florence is based upon the activity of 13 Emergency Mobile Unit (EMU). The activity of such a huge system is difficult to evaluate: we have concentrated our attention upon the diagnostic process assuming that "correct diagnosis = correct treatment = benefit for the patient". Then we compared diagnoses set on EMU to diagnoses made in hospitals, giving to each comparison a score from 1 to 5. In terms of quality the services of the EMS in Florence seem to be effective, since in 72% of cases the Hospital Emergency Department has confirmed the diagnoses achieved under emergency conditions, and in 12% only there has been remarkable difference. Comparing the diagnoses made on EMU to that at the hospital discharge, in two thirds of cases there is excellent correlation.

Ambulances↗
PubMed1984

Consultant evaluation of a hospital medication system: implementation and evaluation of the new system.

The effects of consultant-recommended modifications in a hospital medication system on medication-error rates and response times were evaluated. Fourteen recommendations for improving the medication system in a large teaching hospital were implemented to varying extents over a period of 1.5 years. The response times and medication-error rates of the newly implemented system were then measured using pharmacist-observers as was done in the old medication system. Medication-error rates were then compared on one medical-nursing unit and two surgical-nursing units both before and after implementation of the new system on the medical unit alone. Response times for routine medication orders decreased by 55% compared with the previous system; for "now" and "stat" orders, response times were reduced by 57% for orders filled from the central pharmacy and by 70% for orders filled from medication carts on the nursing units. No significant differences in medication-error rates were found when the old and new medication systems were compared. This finding was attributed primarily to the hospital's failure to implement recommendations related to computer printing and sorting of orders, use of dispensing envelopes for delivering medications in true unit dose form, and packaging of all medications in unit dose form. This study illustrates how the benefits of a unit dose system can be compromised in implementation and the need for close monitoring to ensure that performance standards are maintained.

Consultants↗
PubMedDate not supplied

Designing a National Disaster Medical System.

The National Disaster Medical System (NDMS) is a partnership of private and public sectors to provide care to the victims of great disasters. The system is being developed as a voluntary cooperative effort of four major Federal agencies, State and local governments, and the American professional and hospital communities. A medical response component will include 150 disaster medical assistance units capable of clearing or staging operations in a disaster. Each unit will comprise three 29-person teams containing physicians, nurses, medical technicians, and support personnel and will include a 16-person unit command and support element. An evacuation component will be founded on the military aeromedical evacuation system, augmented by civilian aircraft and other transportation resources. A hospital component will enroll 100,000 pre-committed beds in hospitals throughout the nation. The system is designed to care for up to 100,000 casualties arising from a massive peacetime disaster or an overseas conventional military conflict. The National Disaster Medical System will be implemented over a period of 3 to 5 years. The authors recommend that all parts of the American health care community join in support of the system.

Disaster Planning↗
PubMed2001

[The medical system and its characteristics during the Koryo Dynasty period].

This article explores the medical system of the Koryo Dynasty period and its social characteristics. First, the structure of medical system and roles of medical institutions during the Koryo Dynasty period will be summarized. Then, the characteristics of the medical system will be identified through exploring the principles of its formation in a view of social recognition of medical care and a view of public policy. During the Koryo Dynasty period, medical experts were trained in national education institutions from the early days of Dynasty. After trained, they were appointed to the posts at government service with their medical profession. In the meantime, they sought ways to ascend their social position. Physicians of Oriental medicine were appointed to the posts at each local government and troops to take charge of medical treatments of the common people. Also, the state tried to assume the reins of medical system by actively taking part in circulation (collection and distribution) of herb. Taeuigam and Sangyakguk represent central medical institutions of the Koryo, taking charge of medical service for the aristocracy and the bureaucracy. The Common people were treated at DongSeoDaeBiWOn, JeWuiBo, HyeMinGuk, and YakJum in SeoKyung. However, activities of these institutions became less active around the days of military officials regime, as officers became negligent and financial base went broken. The roles of medical institutions of the Koryo government were not restricted to the treatment of diseases. Policies for the common people were constituted by two main policies, the policy for encouraging agriculture and the policy for giving relief to people. Medical institutions, with other social systems, had a social responsibility to support the governing system of the Koryo and maintain the stability of the society. In this aspect, medical institutions such as DongSeoDaeBiWon and JeWuiBo, and relief institutions such as UiChang, were all related and connected organically, and they were results of, and bases of the relief policy. However, medical system for the common people was made up first for practical needs and then improved successively. Allocation of medical experts and execution of relief work were carried out by each local government, except the case of serious disaster, which central government took part in. As the Koryo Dynasty went into its latter period, temporary institutions and one - time benefits replaced permanent institutions. These four characteristics described above were systemic characteristics of medical system during the Koryo Dynasty period.

History, Medieval↗
PubMed2006

Could a computer-based system including a prevalence function support emergency medical systems and improve the allocation of life support level?

OBJECTIVES: To evaluate whether a computer-based decision support system could be useful for the emergency medical system when identifying patients with acute myocardial infarction (AMI) or life-threatening conditions and thereby improve the allocation of life support level. METHODS: Patients in the Municipality of Göteborg who dialled the dispatch centre due to chest pain during a period of 3 months. To analyse the relationship between patient characteristics (according to a case record form used during an interview) and the response variables (AMI or life-threatening condition), multivariate logistic regression was used. For each patient, the probability of AMI/life-threatening condition was estimated by the model. We used these probabilities retrospectively to allocate advanced life support or basic life support. This model allocation was then compared with the true allocation made by the dispatchers. RESULTS: The sensitivity, that is, the percentage of AMI patients allocated to advanced life support, was 85.7% in relation to the true allocation made by the dispatchers. The corresponding sensitivity regarding allocation made by the model was 92.4% (P=0.17). The specificity was also slightly higher for the model allocation than the dispatcher allocation. Among the 15 patients with AMI who were allocated to basic life support by the dispatchers, nine died (eight during and one after hospitalization). Among the eight patients with AMI allocated to basic life support by the model, only one patient died (in hospital) (P=0.02). CONCLUSION: A computer-based decision support system including a prevalence function could be a valuable tool for allocating the level of life support. The case record form, however, used for the interview can be refined and a model based on a larger sample and confirmed in a prospective study is recommended.

Advanced Cardiac Life Support↗
PubMed1991

The St Croix disaster and the National Disaster Medical System.

The National Disaster Medical System was designed to respond to a catastrophic disaster by creating a group of specially trained civilian disaster medical assistance teams. The teams would be transported to the periphery of the event to triage, stabilize, and then prepare victims for evacuation to facilities elsewhere in the United States that have agreed in advance to accept such patients. Hurricane Hugo's devastation in St Croix offered the first opportunity to test the system. The event was an example of a type of medical disaster that resulted in a sudden reduction in medical resources without a great increase in casualties. Background information and operation of the New Mexico disaster medical assistance team are presented with a clinical profile of the patients seen during the disaster. We describe the first actual deployment of a disaster medical assistance team and the issues that must be addressed before future deployments.

Disaster Planning↗
PubMed1996

The University of Maryland Medical System invests in its community's minorities.

As a private, non-state-owned teaching hospital adjacent to a predominately low income African American community in Baltimore, the University of Maryland Medical System (hereafter called the Medical System) in partnership with the state's medical school has historically provided excellent medical care to the community's residents regardless of their ability to pay. Nevertheless, executive leadership recognized that the Medical System needed to be even more socially and economically responsible to the minority community by investing more of the system's resources in that community. Doing so would improve the economic strength of the community, and this strength would help the Medical System to continue to thrive and expand its business in Baltimore City. Therefore, in the late 1980s, the Medical System created a program that focuses on greater inclusion of minorities particularly African Americans, in personnel, construction, purchasing, and community outreach. In the area of personnel, recruitment efforts have focused on increasing the representation of minorities, particularly African Americans, in management and residency positions. The result has been the creation of a more supportive environment for minority personnel throughout the organization as well as for minority patients and vendors who have dealings with the medical system. In the area of construction, minority development efforts have included the establishment of a flexible bid-award policy and a partnership with the minority business community. As a result, total construction dollars spent with minority-owned firms increased from $2 million to $18 million over seven years, and the portion of these dollars spent with African American-owned firms increased sixfold. In the area of purchased goods and services, more creative approaches to improving minority participation have been necessary. These have included partnering minority distributors with major suppliers and literally assisting in the creation of new minority firms capable of effectively responding to the competitive marketplace. As a result, purchasing dollars spent with minority-owned firms increased from $1.5 million to $3.2 million in four years, and the portion of these dollars spent with African American-owned firms nearly tripled. In community outreach, a comprehensive program has emerged that includes education, career development, disease prevention, and health promotion activities. The Medical System has encountered many barriers to success in these efforts but fortunately has overcome many of them. This article outlines the methods the system has used to achieve its minority development goals, with particular emphasis on the difficult area of purchasing.

Baltimore↗
PubMed1993

The rise and decline of the Cooperative Medical System in rural China.

The Cooperative Medical System (CMS) in China is an established medical system that serves the rural areas and provides treatment and prevention of disease, immunization, family planning, and maternal and child health care services. Past experience suggests that the CMS benefited the peasants in rural China. During the 1980s, following reform of China's economic system, the CMS underwent major changes. In some places, CMS stations evolved into various other types of medical and health care systems; in other places, CMS stations ceased operation altogether. This article attempts to analyze the causes and meaning of these changes, and examines the conditions for continuation of this system.

China↗