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PubMed1980

A simple work measurement system that can aid in effective production planning.

With the advent of increased controls in the hospital field has come the mandate for more efficient use of available resources. Production planning is the mechanism by which these efficiencies can be gained. Ongoing measurement of various work components must be conducted and retrospectively compared to make meaningful use of production planning techniques. The pharmacy department at Brokaw Hospital, which utilizes a unit dose drug distribution system combined with intravenous admixture and monitoring services, has developed an internal measurement system based on key variable weighted units of service. Each component is assigned a value depending on time needed (in minutes) for completion. The units are tabulated daily, with the monthly sum being divided by departmental manhours to yield a monthly productivity ratio. This ratio is used as an aid in making decisions related to work assignments and staff scheduling. Compared against the productivity ratio of a benchmark month of known departmental efficiency (derived by measuring all activities for the month divided by man-hours consumed), projections can be made for future manpower requirements.

Efficiency↗
PubMed1984

Cost effective method of implementing decentralized unit dose pharmacy services in a Friesen setting.

A limited decentralized drug distribution system was implemented at the Graduate Hospital, a 310-bed Friesen Concept teaching hospital. This mobile system services 252 medical/surgical beds on three floors of the hospital. Operation was limited to hours of peak demand for pharmacy services and to initial doses. The system was able to reduce turnaround time from 217 minutes to 90 minutes for 80-85% of newly written orders. Further, the systems was found to increase the availability of the pharmacist as a reference source and to clarify unclear or inappropriate orders. This approach required no increase in full-time equivalents and minimal capital expenditure.

Centralized Hospital Services↗
PubMed2004

Education and certification of laboratory medicine.

Not only are there differences in the definition of a specialist, but there are also different education systems for residents and certifications of specialists of laboratory medicine from country to country. The resident education program, the certification system of specialists of laboratory medicine, requirements for specialist examination, requirements for training hospitals, and the quota system for resident distribution in Korea are reported here for comparison with other countries' systems. Also, the function of a specialist society for laboratory medicine is described, to demonstrate its profound involvement in the education and certification of laboratory medicine.

Certification↗
PubMed2004

The economics of integrated electronic medical record systems.

The decision to adopt electronic medical record systems in private practices is usually based on factors specific to the practice--the cost, cost and timesaving, and impact on quality of care. As evident by the low adoption rates, providers have not found these evaluations compelling. However, it is recognized that the widespread adoption of EMR systems would greatly benefit the health care system as a whole. One explanation for the lack of adoption is that there is a misalignment of the costs and benefits of EMR systems across the health care system. In this paper we present an economic model of the adoption of EMR systems that explicitly represents the distribution of costs and benefits across stakeholders (physicians, hospitals, insurers, etc.). We discuss incentive systems for balancing the costs and benefits and, thus, promoting the faster adoption of EMR systems. Finally, we describe our plan to extend the model and to use real-world data to evaluate our model.

Costs and Cost Analysis↗
PubMed1995

Automation in pharmacy: two institutions' experiences with novel distribution systems.

A computerized medication system, implemented at Rochester (MN) Methodist Hospital in 1987, has been adopted by the hospitals at the Mayo Medical Center, Rochester, MN. A key component of the medication system, which uses individualized patient medication envelopes, is the delivery of doses of medications to nursing units just before their administration time. The system has been shown to provide greater nursing support, increase patient safety by reducing medication errors, and decrease both full-time equivalent costs and operating costs. The immediate impact of the system has been to shift dose scheduling from a nursing to a pharmacy responsibility. At Duke University, an automated pharmacy system (APS) has been in operation since October 1993 and is used to dispense the majority of unit dose drugs. The APS provides up-to-the-minute information about the drugs that patients are receiving, which is used to fill each patient's unit dose drawer. It has not dispensed an incorrect drug since its installation and has allowed centralization of the unit dose cart system. Other benefits include decreased billing labor and increased drug usage reporting.

Automation↗
PubMed1994

[Computer alert and quality of care: application to the surveillance of hospital infections].

The Centre Informatique of Geneva University Hospital is developing, in the environment of its hospital information system, DIOGENE, a computerized alert system for surveillance of hospital infections. This hospital information system is based on an open distributed architecture and a relational database system, and covers many medical applications. This environment allows the development of alerts useful for detecting patients at risk. The alerts offer to clinicians a mean to control their efficacy in patient care. They are a new application of telematics for surveillance in clinical epidemiology, and are a tool for quality assurance. Two examples of alerts established for hospital infection control activities are presented. The first alert systematically detects all cases of patients colonized by or infected with methicillin-resistant Staphylococcus aureus (MRSA). The second alert helps to organize prospective surveillance of bloodstream infections in order to identify some risk factors for infection and propose preventive measures.

Cost of Illness↗
PubMed1996

Materiel management: time for a new beginning.

Industry forecasters have predicted that most hospitals will belong to a multi-hospital system or an alliance by the end of this decade or they will simply disappear. This will concomitantly expand and contract the role of materiel managers, while creating new challenges for them in free-standing hospitals or in a multi-hospital system environment. What should materiel management's role be in this new arena? What functions or activities should materiel management be responsible for functionally or administratively? How should a hospital or multi-hospital system's materiel management department be organized to meet this new challenge? What relationship should evolve between hospital divisions and the system's materiel management department? Who should control the purchasing, inventories, and distribution for hospital divisions? What functions should be centralized and what should be decentralized? The answers to these questions will be discussed in this article.

Cost Control↗
PubMed1978

Hospital policies and procedures: even 'the system' needs a system.

Hospitals need effective systems for recommending, coordinating, writing, distributing, and implementing policies and procedures. Some features of an effective system include use of a coordinator, interdepartmental cooperation, and well designed forms and manuals. Some of the benefits include better management and better coordination with regulatory bodies and requirements.

Accreditation↗
PubMed1996

[A clinical study on optimization of dose distribution in 60Co RALS for carcinoma of the uterine cervix using X-ray CT images].

From 1983 to 1992, 248 patients with carcinoma of the uterine cervix were treated with intracavitary radiation therapy using the 60Co remotely controlled high dose rate afterloading system apace (RALS). Five-year survival rates were 92,8 +/- 7 % for Stage I, 72.4 +/- 5% for Stage II and 52.1 +/- 4% for Stage III. The relations among the sequelae in surrounding organs, local control rates and the calculated dose in the rectum, sigmoid colon, bladder and small intestine were evaluated using X-ray CT images. The patients were treated with intracavitary radiation of 6 Gy/fraction at point A. A total of 5 fractions were delivered once a week. The dose calculation was performed by, and dose distribution shown on, a system developed in our hospital with a personal computer. The average values of maximum dose at certain points of the walls of the rectum and sigmoid colon were similar to point A dose. The incidence of late sequelae increased significantly in the group receiving a maximum dose to the rectum and sigmoid colon higher than 8 space Gy/fraction. This report describes the program for automatic optimization of dose distribution by modifying the hot spot (higher than 8 space Gy/fraction) and the cold spot (lower than 6 space Gy/ fraction).

Adenocarcinoma↗
PubMed1993

Intercomparison of radiotherapy treatment planning systems for external photon and electron beam dose calculations.

Dose distributions calculated by six different treatment planning systems (TPSs), used by the hospitals in Finland or in Russia, were compared with measured dose distributions. Five typical cases of irradiation were selected: regular fields, oblique incidence, irregular field, wedge field and inhomogeneity in a water equivalent phantom. The beam data for each TPS where those pertaining to the beam where the comparative relative measurements were performed. The results indicate that the dose distributions produced by different TPSs can differ from each other as well as from the measured dose distributions up to a level which is not acceptable in terms of the ICRU recommendations. Greatest differences seem to be related to the omission or undue consideration of the scatter components of the beam.

Algorithms↗
PubMed2003

Pharmaceutical care: pharmacy involvement in prescribing in an acute-care hospital.

BACKGROUND: [corrected] Pharmaceutical care implies reaching a consensus with physicians on prescriptions in cases that call for the substitution of one active ingredient for another, a modification in dose, frequency, route of administration, etc., through the unit-dose distribution system. The goal of pharmacist interventions in the hospital should be to achieve a rational use of drugs; to ensure this, a daily review of patient prescriptions by a pharmacist is necessary. Most of the incidence of drug-related morbidity and mortality is predictable and can be avoided, thus reducing the overall cost of health care and the duration of hospitalization while improving the quality of care. The optimum quality of physician or pharmacist care to be achieved would be one that which maximizes benefits and minimizes risks and costs. OBJECTIVE: The goal of this study was to evaluate pharmacist interventions at the Hospital of Barcelona over a six-month period and their clinical and economic repercussions and the degree of compliance. METHOD: The interventions were recorded on a card and classified by type: antibiotic or thromboembolic prophylaxis; substitution of an active principle not included in the hospital's Pharmacotherapeutic Guide; change in dose or route of administration; therapeutic duplication; dose adjustment of aminoglycosides and vancomycin; and inappropriate treatment duration. The economic evaluation considered the average cost of a hospital stay and of the procedures and diagnostics in 1998 and applied data on published probability rates and drug costs. RESULTS: A total of 3,136 interventions were analyzed prospectively during the study period. The interventions represented savings of 129,058.31 euros. Those that contributed most to these savings were recommendations for antibiotic prophylaxis, thromboembolic prophylaxis and pharmacokinetics studies: 49.4, 47 and 5.7% of interventions, respectively, and 79, 3.6 and 15% of total savings, respectively. CONCLUSION: In general, the degree of acceptance of the interventions was high (88.8%), as a result of the growing compliance by physicians with the hospital's established protocols. It can be concluded that pharmacist interventions have been useful to improve patient care and have been important to help educate physicians on the quality of drug therapy.

Anti-Bacterial Agents↗
PubMed1991

Estimating frequency of disease findings from combined hospital databases: a UMLS project.

Merging data from the Salt Lake VA hospital database and the LDS hospital HELP system into a UMLS sponsored unified patient database has demonstrated that distribution of variables within a disease is hospital independent. Although disease prevalence is clearly not the same among hospitals, analysis of data within a disease group across hospitals can be done using such a merged database. This unified patient database would allow study of unusual diseases not possible using data from a single institution.

Databases, Factual↗