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PubMed1983

Description of an experimental hospital pharmacy management information system.

The objectives, characteristics, and uses of hospital pharmacy work-measurement systems are discussed, and the development and operation of an experimental hospital pharmacy management information system (HPMIS) is described. Hospital pharmacy work-measurement systems are designed to measure and evaluate the productivity of a hospital pharmacy or group of pharmacies. Previous work-measurement systems used by hospital pharmacies have been too time consuming or imprecise for widespread use. A national hospital pharmacy work-measurement system known as HPMIS was developed to provide comprehensive and widely applicable information on pharmacy expenses, personnel use, and productivity. HPMIS converts data from participating hospitals into 17 indicators that enhance the comparability of the information between the hospitals. The 17 indicators relate to pharmacy production, clinical services, and administrative functions; also included are several gross department indicators that combine elements of all three areas. After analysis and categorization of the data according to characteristics such as bed size, geographical location, and type of drug-distribution system, results are reported to individual hospitals. A national work-measurement system such as HPMIS should enable hospitals to evaluate their pharmacy operations in relation to those of other hospitals and to track their department's relative management performance over time.

Efficiency↗
PubMed1992

Pharmaceutical services in rural hospitals in Illinois--1991.

The results of a 1991 survey of pharmaceutical services in rural hospitals in Illinois are reported and compared with the results of previously published national and regional surveys. A questionnaire was developed and mailed to the director of pharmacy at each hospital in the study population (n = 95 rural hospitals in Illinois) to obtain information about inpatient drug distribution services, ambulatory-care services, clinical services, and human resources. The response rate was 81% (77 usable responses). Respondents reported a mean hospital size of 115.5 licensed beds. The mean average daily census was 51.2. Drug distribution systems appear similar to those reported in the 1990 ASHP survey, with complete unit dose drug distribution systems existing in 90.1% of respondent rural Illinois hospitals and complete and comprehensive i.v. admixture services in 71.2%. The percentage of pharmacy departments that are decentralized is lower among rural Illinois hospitals than among previous survey populations. Respondents indicated that they provided the following clinical pharmacy services: drug therapy monitoring (73%), patient rounds (12.2%), nutritional support (37.8%), pharmacokinetic consultations (32.4%), and patient education and counseling (24.3%). These results are comparable to those reported in previous surveys. Respondents reported an average of 5.9 full-time equivalents per hospital pharmacy department. The pharmacist vacancy rate and the total vacancy rate per department were reported as 10% and 5.3%, respectively, with vacant positions taking an average of 15 months to fill. The pharmacist vacancy rate is markedly higher than that reported in the 1990 ASHP survey. Rural Illinois hospitals are comparable to other U.S. hospitals in the provision of most pharmaceutical services.(ABSTRACT TRUNCATED AT 250 WORDS)

Ambulatory Care↗
PubMed1976

Computerized pharmacy services in a large community hospital.

A computerized pharmacy system dealing with drug distribution, clinical services and administrative services is described. Present systems, implemented for 50% of the institution's beds, are discussed fully. Future applications of the system are outlined.

Computers↗
PubMed1996

Venturing into new territory--health systems as Medicare risk contractors.

With each congressional budget debate, hospital and health system executives are reminded of their vulnerability to Medicare reimbursement rates. As health maintenance organizations (HMOs) have entered into Medicare risk contracts and negotiated separate hospital reimbursement rates, hospital and health system executives have recognized even less control of their Medicare reimbursement. One way for health systems to regain control of the Medicare dollar is to develop a Medicare risk contract that directly receives and distributes the Medicare risk premium. Before hospital and health system executives invest in the start-up and operational capital necessary to bid for a risk contract, careful analysis of the efficacy of the contract's contribution to the margin should be undertaken. The following will review observations and lessons from HMO Medicare risk contracting and introduce a methodology that health system executives can use to evaluate the annual financial impact of entering the business of direct Medicare risk contracting.

Capitation Fee↗
PubMed2006

Prospective 3-year surveillance for nosocomial and environmental Legionella pneumophila: implications for infection control.

OBJECTIVES: To perform a 3-year, prospective surveillance program for legionnaires disease (LD) in a large university hospital in Rome, and to assess the usefulness of the hospital water monitoring program in predicting the risk of nosocomial LD. METHODS: Samples from patients with new cases of nosocomial pneumonia were sent for legionella laboratory investigations. Meanwhile, water samples for bacteriological analysis were collected every 6 months from high- and medium-risk hospital wards (10 in total). Legionella pneumophila isolates collected were serotyped and analyzed by pulsed-field gel electrophoresis. RESULTS: From June 2001 through May 2004, the pneumonia surveillance identified one case of nosocomial LD among 43 cases of nosocomial pneumonia (2.3%). Environmental investigations detected L. pneumophila in 12 (18.7%) of the 64 water samples, of which 50% belonged to serogroup 1. The L. pneumophila count and the percentage of positive locations never exceeded 10(2) colony-forming units/L and 20%, respectively, except when the LD nosocomial case occurred (positive water samples, 40%; L. pneumophila count, <10(2) colony-forming units/L). Genotyping showed 3 prevalent clones of L. pneumophila in the water distribution network, of which one persisted over the 3 years. One clone contained 3 different L. pneumophila serogroups (2, 4, and 6). CONCLUSIONS: The low incidence of nosocomial cases of LD appears to be associated with a low percentage (<20%) of positive water samples per semester and with a low contamination level (<10(2) colony-forming units/L). An infection control system for nosocomial LD should, therefore, be based on both environmental and clinical surveillance, together with the appropriate maintenance of the hospital water distribution system.

Cross Infection↗
PubMed1981

Distribution system for controlled substances in the operating room.

A system of drug distribution for controlled substances in a hospital operating room is described. Problems in accountability for and accessibility to controlled substances distributed by a floor stock method led to the new system. Small, lockable narcotic cases contain a sufficient quantity of Valium, Innovar, ans Sublimaze for one shift. Each nurse anesthetist signs out a narcotic case from the pharmacy at the beginning of the shift and is responsible for its contents until it is returned to the pharmacy at the end of the shift. Administration records are dept by the nurse anesthetist. A discrepancy in the count results in an incident report automatically and an investigation. The system has improved the drug distribution process in our operating room and is easily adaptable to other institutions.

Humans↗
PubMed1975

[Experience in organizing a system of stepwise reabilitation for the mentally ill].

The paper deals with the organization of a system of rehabilitative treatment of mental patients in conditions of a large and industrially developed region. It is stressed that in order to organize a wide range of readaptation measures it is necessary to have material security, an expedient distribution of hospital beds, a high standard system of a continuity between the in-patient and out-patient (including day hospitals and occupational shops) services. In this light it is very important to know the general principals of treatment by social methods and a correct succession of therapeutical measures and a gradual readaptation, adequate to the mental condition of the patient. The effectiveness of the mentioned measures is confirmed by figures.

Hospital Administration↗
PubMed1982

Pharmaceutical services in a veterinary hospital and clinic.

The pharmaceutical services offered by hospital pharmacists to a veterinary hospital and clinic are described. At Washington State University, the Department of Veterinary Clinical Medicine and Surgery of the College of Veterinary Medicine approached the College of Pharmacy to evaluate the pharmaceutical services in terms of lost charges and to provide recommendations for needed changes. The records of 18 cases were surveyed, and an inventory was taken in two wards to determine outdated drug products, products without expiration dates, and product duplication. The survey and inventory revealed inefficiencies and waste in the billing and distribution systems. The findings indicated the feasibility and potential cost-effectiveness of employing hospital pharmacists to manage the drug distribution system. A combined floor stock and individual prescription order system was implemented under the direction of a pharmacist faculty member jointly appointed by the two colleges. The distribution system has been in successful operation for two years, and the relationship between the two colleges has prompted the development of shared academic positions and joint clinical research.

Animals↗
PubMed1990

Improving management practices: a case study of linen usage.

As part of an action research project, a thorough review was undertaken into the system for linen acquisition, distribution and usage in a large metropolitan hospital. As a result, new systems of management control were introduced, with considerable cost savings resulting. The project illustrated the importance to effective hospital management of the implementation of systematic review and redesign processes to incorporate measurement and accountability into management systems.

Bedding and Linens↗
PubMed2001

Merits of duplicate LAN cabling in hospitals.

Our hospital wired three LAN cables separately to improve the data distribution range. One LAN is between the various sections of the hospital (hospital LAN), another is within each section (section LAN), and the other is connected to the Internet (open LAN). The section LAN was connected to the hospital LAN to enable data exchange. Data from the section LAN for common use is collected through the hospital LAN and stored in the central server The duplicate cabling and separate LANs increased the independence of each LAN and the system within each section. The section systems can be changed at anytime without the necessity of reconstructing the whole hospital information system. The data transfer speed of each cable increased. Hospital information processing systems often use a distributed-processing centralized management system. Because of advances in technology, each section can now take responsibility for developing their own system, making the responsibility of the information processing section responsible for hospital information systems more limited than previously. Herein, we show the merits of separate cable installation.

Centralized Hospital Services↗
PubMed1991

The effective pharmacy-nursing committee.

The Saint Joseph's Hospital Pharmacy-Nursing Committee sees a long list of pharmacy-nursing and drug distribution system problems still to be addressed and has no worry about running out of new business. In fact, increasing controlled substances accountability, creating a more reliable and timely process for moving intravenous fluid pumps through the inpatient system, and implementing a pharmacy-based, patient-controlled analgesia program across all of the hospitals' wards are three major issues now being addressed by the committee. At Saint Joseph's Hospital there is not a lot of unnecessary handwringing or undue stress over major pharmacy-nursing issues. Issues do exist, but there is also an experienced Pharmacy-Nursing Committee with a good track record of being able to resolve major issues. The committee takes on problems in a healthy and confident atmosphere of trust in both profession's skills and competencies. There is a respectful knowledge of each discipline's professional responsibilities and a full awareness that a quality patient drug system requires pharmacy and nursing elements working closely together. Wrestling with the heavy, modern-day, hospital pharmacy-nursing drug distribution system issues at this facility actually can be fun as a result of the confidence, camaraderie, and empathy that exists within the Pharmacy-Nursing Committee.

Clinical Pharmacy Information Systems↗
PubMed1992

Computers in healthcare: overview and bibliography.

OBJECTIVE: The objective of this article is to provide an overview of computer technology and an associated bibliography, emphasizing institutional-based healthcare applications and pharmacoinformatics. DATA SOURCES: References were selected from the authors' files and from a computerized search over the last five years on computers in healthcare/medical informatics and in pharmacy. STUDY SELECTION: Articles selected for review and discussion were considered to be important contributions to the respective areas listed in the bibliography and representative of advancements in computer applications in healthcare and pharmacy. DATA SYNTHESIS: The computer has become an important support tool for healthcare professionals. Medical informatics and the discipline related to pharmacy, called pharmacoinformatics, have evolved from the cognitive underpinnings of medicine, pharmacy, and computer science. Recent developments in computer technology have resulted in computers that are fast, increasingly portable, and user friendly. Hospital information systems employ computers in various ways to deal with the vast amount of information used by various departments. Standards for electronic data exchange are being developed to increase the integration potential of these systems. Hospital pharmacists have used computers for drug distribution, financial analysis and inventory control, drug interaction detection, pharmacokinetic dosing, drug information, and drug therapy monitoring. Expert systems are being developed in several areas of drug therapy. Pharmacy educators have developed interactive courseware to help students learn problem-solving skills in the areas of calculations, therapeutics, and drug information. CONCLUSIONS: Pharmacists need to become more involved with applications of technology to pharmacy. Properly implemented, computers can provide more time for pharmacists to use their cognitive skills in the delivery of pharmaceutical care.

Clinical Pharmacy Information Systems↗
PubMed1980

Audit mechanism for hospital drug distribution.

The development and application of a pharmacy department audit of its unit dose drug distribution system is described. Criteria used in the program were based on broad drug distribution criteria developed by the Minnesota Society of Hospital Pharmacists' PSRO Liaison Committee, with subcriteria developed by the staff of the hospital pharmacy department. Month-long audits are based on one of three criteria. A committee consisting of two staff pharmacists, one administrative pharmacist and one technician audits a predetermined number of randomly selected medication orders, medication profiles, filled medication orders or medication drawers. Deficiency patterns are identified, and appropriate corrective action is taken. Audits require approximately eight hours of pharmacist time and three hours of technician time per month per criterion. Audit of the drug distribution system makes pharmacy staff more aware of the quality of service it provides.

Hospital Bed Capacity, 500 and over↗
PubMed1998

A hospital-wide distributed PACS based on intranet.

A hospital-wide Picture Archiving and Communication System (PACS) is currently under development at the University Hospital of Geneva. After a first implementation including two oneterabyte optical libraries, the system is expanded to integrate all the imaging modalities of the hospital. The new storage requirement is 10 terabytes to cover three year archive. A large distributed image archive has been designed including new archive servers for long-term storage and display servers for medium-term storage. The acquisition, archive and distribution cycles are performed using separated networks combining Fast Ethernet and Ethernet. Image files are distributed to the wide-hospital using a prefetching strategy or an Intranet server, RADIOLAB. The first mode takes advantage of the fully integrated hospital information system DIOGENE 2 to allow the automatic retrieval of studies in advance. The second mode provides a convivial study selection from any conventional WWW (World Wide Web) browser. Image files are then transmitted to the user's display station using HTTP (HyperText Transfer Protocol) and handled by OSIRIS software, which acts as a helper or viewer. Such a system is expected to meet the time requirement, which is less than three seconds per image.

Computer Communication Networks↗
PubMed2003

Quantile regression: a statistical tool for out-of-hospital research.

The performance of out-of-hospital systems is frequently evaluated based on the times taken to respond to emergency requests and to transport patients to hospital. The 90th percentile is a common statistic used to measure these indicators, since they reflect performance for most patients. Traditional regression models, which assess how the mean of a distribution varies with changes in patient or system characteristics, are thus of limited use to researchers in out-of-hospital care. In contrast, quantile regression models estimate how specified quantiles (or percentiles) of the distribution of the outcome variable vary with patient or system characteristics. The authors examined the performance of traditional linear regression vs. that of quantile regression to assess the association between hospital transport interval and patient and system characteristics. They demonstrate that richer inferences can be drawn from the data using quantile regression, utilizing data drawn from a study of ambulance diversion and out-of-hospital delay. The results demonstrate that the effect of ambulance diversion upon out-of-hospital transport intervals is not uniform, but is worse on the right tail of the distribution of transport intervals. In other words, ambulance diversion disproportionately affects those patients who already have longer transport intervals. Second, the distribution of transport intervals, conditional on a given set of variables, is positively skewed, and not uniformly or symmetrically distributed. The flexibility of quantile regression models makes them particularly well suited to out-of-hospital research, and they may allow for more relevant evaluation of out-of-hospital system performance.

Ambulances↗
PubMedDate not supplied

[Levis Hospital: from the team system to global care].

Nurses at H otel-Dieu de L-evis modified the hospital's care distribution with a view to replacing the existing team system by a care organization model t enables them to fully exercise their autonomy while providing optimum-quality ca maintaining control over costs. The process chosen is a hybrid comprehensive car care system. Introduced initially on the surgery unit day shift according to an founded on planned-change theory, the system is now in effect in all of the hospital's care units. In introducing and implementing the change, the nurses followed a fi procedure: raising of awareness within the health-care setting, definition of in needs, training of personnel, testing of the care distribution model as part of project, and assessment of the project.

Continuity of Patient Care↗
PubMed1978

Delayed flow of patients in a Black hospital.

Two hundred consecutive patients who were discharged from a ward in a Black hospital were studied with reference to delay of flow through a system. Problems are discussed, e.g. that of the young patient, admitted at night, who awaits radiography and investigations. Because he is unable to give consent, he must wait for an operation until appropriate staff and consent are available. He recovers, may have to wait for a surgical appliance, is discharged and may then have to wait several more days before relatives collect him. The unique problems in Black hospitals can be alleviated, inter alia, by departmental admission protocols, outpatient liaison education officers, more even distribution of medical manpower, improved hospital transport systems and overnight stay wards incorporated in a more active outpatient system to replace the present sorting system.

Black or African American↗