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UNLABELLED: A four-pronged approach to improving the blood product delivery system resulted in a significant decrease in the number of blood products ordered STAT, increased ability of the blood bank to fulfill STAT requests in a timely manner, and a significant decrease in the number of blood products outdated and discarded. KEYWORDS: blood products, performance improvement
The State of Rhode Island conducted an exercise to obtain and dispense a large volume of emergency medical supplies in response to a mass casualty incident. The exercise was conducted in stages that included requesting supplies from the Strategic National Stockpile and distributing the supplies around the state. The lessons learned included how to better structure an exercise, what types of problems were encountered with requesting and distributing supplies, how to better work with members of the private medical community who are not involved in disaster planning, and how to become aware of the needs of special population groups.
In 1993 a survey of the food service departments in 159 hospitals in New South Wales was carried out using a mailed questionnaire, and the results were compared with those of a similar survey in 1986. The results reveal that over the past seven years there has been a significant increase in the proportion of hospitals using cook-chill systems, from 5 per cent in 1986 to 18 per cent in 1993. Hospitals with cook-chill systems do not appear to be operating more efficiently than those with conventional catering systems: in cook-chill hospitals the mean food service staffing ratio was 7.1 beds/full-time equivalent (FTE) compared to 7.8 beds/FTE in hospitals with cook-serve systems. Most hospitals in New South Wales still use traditional hot food delivery to the wards, and more of these are now using effective heat maintenance systems for patient meals. The proportion of special diet meals has increased over the past seven years to 17.1 per cent in public hospitals. The percentage of food service departments with an unqualified person in charge fell from 47 per cent in 1986 to 22 per cent in 1993. Meal times remain largely unchanged, with more than 90 per cent of hospitals still serving the evening meal before 5.30pm.
The proposal is not new or radical in that currently many small works are and historical have been carried out implicitly utilising this system. Furthermore, this idea is not suggesting that M&E consultants be omitted from the process only that their role be redefined in terms of approving/checking proposals/installations/commissioning etc. There is an appropriate form of contract already available through JCT '80 why not utilise it? As is being done with boilers, water treatment, lifts etc. etc. The recommendation would improve quality, reduce time and cost, directly apportion accountability and involve the knowledgeable professionals within the industry.
In fall 1997, a shortage of intravenous immunoglobulin (IVIG) developed in the United States because of increased demand for the product, reduced supply, and product recalls. This shortage is a useful model for understanding how our health care system responds to scarcity. Although the U.S. government took steps to inform the medical community of the shortage, with few exceptions, the government did not respond to the shortage in a timely or effective manner. Instead, it took a relatively passive role, leaving IVIG manufacturers and distributors, health care institutions, and clinicians to fend for themselves. The shortage likely had an uneven impact on patients, based on the relative market strength of the health care institutions in which they received care and the individual patient's ability to absorb the increasing out-of-pocket costs of scarce IVIG. Market mechanisms have now largely alleviated the shortage and significantly reduced its detrimental impact on patients. However, future shortages of IVIG or other scarce medical products, such as vaccines and antibiotics, would benefit from more immediate and coordinated efforts not only to make sure that scarce health care resources are distributed in a just manner but also to identify and remedy the sources of health product supply problems.
Nosocomial pneumonia caused simultaneously by two organisms, Legionella pneumophila and the Pittsburgh pneumonia agent, was documented in seven patients in one institution. In all seven cases, both organisms were demonstrated by isolation from culture or visualization by direct immunofluorescence. Four patients died as a result of pneumonia, including two who received erythromycin therapy. The hospital water distribution system appeared to be the reservoir for both L. pneumophila and Pittsburgh pneumonia agent. These seven cases constituted 26.9 percent and 17.9 percent of the cases of Pittsburgh pneumonia agent and Legionnaires' disease, respectively, at one institution. Given this relatively high incidence of dual infection, it is likely that the mode of transmission for both organisms is identical. Dual infection may account for some cases of antibody response to more than one Legionella species. Historical parallels of the discovery of L. pneumophila and Pittsburgh pneumonia agent are reviewed.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
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Although medical and nursing audit is attaining a high profile in UK hospitals, the development of objective measures remains a challenge. The availability and storage or urinary catheters was recorded by a point prevalence survey in a District General Hospital. A "long-term" and "short-term" catheter were provided in all areas, but seven further brands of catheter were found. Female length catheters were rarely available. With some limited exceptions there were no written or verbal policies concerning selection of catheters in the wards. Excess numbers of catheters were stored by wards responsible for their own ordering. Damage of catheters during storage was noted. The survey provided a simple, rapid and inexpensive method of audit to rationalise and improve the provision of catheters. The implementation of a policy incorporating the selection, ordering, storage and use of such equipment will both optimise patient care and maximise efficient budgeting.
Because linen is an item used by virtually every inpatient in the hospital, hospital administrators will find that if they provide laundry managers an appropriate data base, they can motivate them to a larger role of linen use managers.
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The successful management of mass casualty incidents (MCIs) requires standardization of planning, training, and deployment of response. Recent events in the United States, most importantly the Hurricane season in 2005, demonstrated a lack of a unified response plan at local, regional, state, and federal levels. A standard Israeli protocol for hospital preparedness for conventional MCIs, produced by the Office of Emergency Preparedness of the Israeli Ministry of Health, has been reviewed, modified, adapted, and tested in both drills and actual events at a large university medical center in the United States. Lessons learned from this process are herein presented as the10 most important steps (ie, Commandments) to follow when preparing hospitals to be able to respond to conventional MCIs. The standard Israeli emergency protocols have proved to be universally adaptable, flexible, and designed to be adapted by any healthcare institution, regardless of its size and location.
A six-step plan based on using statistics was designed to improve quality in the central processing and distribution department of a 223-bed hospital in Oakland, CA. This article describes how the plan was implemented sequentially, starting with the crucial first step of obtaining administrative support. The QI project succeeded in overcoming beginners' fear of statistics and in training both managers and staff to use inspection checklists, Pareto charts, cause-and-effect diagrams, and control charts. The best outcome of the program was the increased commitment to quality improvement by the members of the department.