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Continuity of care and outcome in nursing home patients transferred to a community hospital.

This study prospectively investigated the effect of continuity of primary physician care on functional ability and outcome of nursing home patients transferred to a community hospital. Evaluated were 335 consecutive transfers with concurrent chart review and a standardized functional rating scale on admission and discharge from the hospital. Continuity of care by the primary physician was more likely with a greater length of stay. There was no association of continuity with age, sex, initial functional status or mental status of the patient, type of admission, or payment source. No significant relationship was found between outcome and continuity of care by the primary physician. Logistic regression analysis indicated that emergency admission to the hospital conferred an increased risk of mortality but that the level of primary physician continuity did not.

Aged↗
PubMed1984

Progressive pharmaceutical services in a small community hospital.

The pharmaceutical services in an 86-bed community hospital in rural Maine are described. With a staff of two full-time pharmacists, one hospital pharmacy resident, and 2.6 full-time equivalent technicians, the pharmacy department operates a 24-hour unit dose drug distribution system with complete i.v. admixture services. In addition, the department supervises nurses on medication administration and i.v. therapy teams. Clinical pharmacy services include patient-education programs, protocols giving pharmacists responsibility for initiating and monitoring specific drug therapies when authorized by a physician, and concurrent antibiotic review. The department publishes a bimonthly newsletter for physicians and nurses and a quarterly newsletter for hospital employees and patients; it also conducts continuing-education programs for nurses. By maintaining a delicate balance between creativity and practicality, pharmacists in small hospitals can develop progressive services.

Anti-Bacterial Agents↗
PubMed1980

High-yield referral criteria for posttraumatic skull roentgenography. Response of physicians and accuracy of criteria.

We evaluated a list of high-yield criteria (HYL) as a means of reducing posttraumatic skull roentgenograms and as a diagnostic test for skull fractures. Physicians requested roentgenograms for 76.9% of head trauma patients in a four-month control period, but for only 46.1% during a four-month experimental period, a relative decrease of 40%. When the experiment ended, roentgenogram use increased to 72% of head trauma patients. The HYL accurately classified 92.5% of the patients with and 84.5% of the patients without pathological conditions. The HYL displayed substantial differences in sensitivity and specificity from HYLs used previously. Clinicians disliked the HYL, believing it was inaccurate and a monitoring device. We conclude that criteria lists can effectively decrease requests for roentogenograms and should be carefully evaluated as diagnostic tests for accuracy and adverse outcomes.

Concurrent Review↗