Selecting a tray distribution system.
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Equipment and Supplies, Hospital↗
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Materials handling systems. A survey of automatic materials distribution systems.
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Automation↗
The effect of medication distribution systems on medication errors.
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Computers↗
Influence of a statewide trauma system on location of hospitalization and outcome of injured patients.
OBJECTIVE: Evaluate the influence of implementing the Oregon statewide trauma system on admission distribution and risk of death. DESIGN: Retrospective pre- and posttrauma system analyses of hospital discharge data regarding injured patients with one or more of the following injuries: head, chest, spleen/liver, pelvic fracture, and femur/tibia fracture. MATERIALS AND METHODS: Risk-adjusted odds ratio of admission to Level I or II (tertiary care) trauma centers, and odds ratio of death were determined using hospital discharge abstract data on 27,633 patients. Patients treated in 1985-1987, before trauma system establishment, were compared to patients treated in 1991-1993 after the trauma system was functioning. MEASUREMENTS AND MAIN RESULTS: After trauma system implementation, the odds ratio of admission to Level I or II trauma centers increased (odds ratio 2.36, 95% confidence interval 2.24-2.49). In addition, the odds ratio of death for injured patients declined after trauma system establishment (odds ratio 0.82, confidence interval 0.73-0.92). CONCLUSIONS: The Oregon trauma system was successfully implemented with more patients with index injuries admitted to hospitals judged most capable of managing trauma patients. The Oregon trauma system also appears beneficial since trauma system establishment is associated with a statewide reduction in risk of death.
Abbreviated Injury Scale↗
Design and implementation of a web-enabled haematological system.
This paper describes the design and the implementation of a web-enabled integrated haematological system, named e-HS. The proposed system runs on a set of distributed network nodes providing useful haematological services. These services include patient-oriented data management, digitized histopathological slides (DHS) acquisition, teleconsulting facilities, etc. The objective of e-HS is to supply web-enabled services according to haematological requirements, implement a distributed storage scheme for DHS, and provide a common database containing all haematological laboratory results by using eXtensible Markup Language (XML) and web technologies. Our implementation can be accessible to every authorized physician at the distributed nodes without any additional software. The only software required for the user is the widely used browser (e.g. MS Internet Explorer v 3.02 or higher). Besides, by using a self-explaining user interfaces and HTML-techniques, such as hyperlinks, the necessary amount of training at the physicians-side is reduced to a minimum. A first implementation of the e-HS, has been established at the Medical Physics Department of the University of Patras (master node of the system), and has been tested with success by the medical staff of the Hospital Departments of the University of Patras and Thessalonica that served as distributed nodes of the system.
Clinical Laboratory Information Systems↗
ARCHIMED: a Network of Integrated Information Systems.
ARCHIMED is a Network of Integrated Information Systems (NIIS). This novel concept of hospital information system has a major advantage over the currently used distributed systems. The normalized representation structure of its databases enable its Navigators to reach simultaneously not only the data coming from different hospital departments, laboratories, and other hospital facilities, but also the data from different hospitals associated in the network.
Computer Communication Networks↗
Isolation of Legionella pneumophila from water systems: methods and preliminary results.
A preliminary survey of water systems in hospitals and hotels showed that Legionella pneumophila may be found in water storage and distribution systems as well as in the recirculating cooling water of air-conditioning plants. Altogether 42 isolates of L pneumophila were made from 31 establishments, six of which were associated with cases of legionnaires' disease but in 25 of which there was no known association with disease. In the six establishments implicated epidemiologically as the source of legionnaires' disease, these organisms were found in each of their water-distribution systems and also in the cooling water from each of the three with cooling towers. In establishments not associated with cases, water from three out of nine cooling towers, four out of 24 taps or showers, and one out of 15 storage tanks was found to contain legionellae. The organisms were isolated by guinea-pig inoculation and subsequent culture of their peritoneal fluid, liver, and spleen. Finding L pneumophila in water systems in the absence of cases of legionnaires' disease should not at present be an indication for attempts at eradication.
Air Conditioning↗
Nosocomial Legionella pneumophila serogroup 5 outbreak associated with persistent colonization of a hospital water system.
An outbreak of infections caused by Legionella pneumophila serogroup 5 was detected in a university hospital, and nosocomial reservoirs of the legionella epidemic were examined. Clinical isolates from two patients who had been affected by the L. pneumophila serogroup 5 outbreak, and from another patient with a legionella infection caused by the same serogroup 3 years later, were compared to L. pneumophila serogroup 5 isolates from the hospital water supply by two molecular methods, amplified fragment length polymorphism (AFLP) analysis and random amplified polymorphic DNA analysis (RAPD). Genotyping confirmed the epidemiological linkage of the first two patients, and linked their infections with the hospital water supply. The third clinical strain, which was also linked to the hospital water, was very similar to the epidemic strain. Even though the water distribution system was sanitized (superheat and flush sanitation), the epidemic strain was shown to be persisting in the hospital water outlets several years after its initial discovery.
Adult↗
Nosocomial Legionnaires' disease uncovered in a prospective pneumonia study.
Most hospitals have yet to record a case of nosocomial legionnaires' disease; the importance of isolation of Legionella pneumophila in the water system of such an institution is unclear. We undertook a prospective pneumonia study in tandem at a veterans hospital where legionnaires' disease was known to be endemic and a community teaching hospital where legionnaires' disease had never been documented. Legionella serological tests were performed on all patients with pneumonia; selective culture media and direct fluorescent antibody testing for Legionella were made readily available. Simultaneous environmental surveys for Legionella were performed. At the community hospital, we discovered that 64% of sites in the water distribution system yielded L pneumophila and that 14.3% of nosocomial pneumonias were legionnaires' disease. The epidemiologic implications of these findings are discussed. Options concerning case detection and eradication measures in the face of hospital water contamination with L pneumophila are presented.
Adult↗
Differentiation of distribution systems, source water, and clinical coliforms by DNA analysis.
During a 2-week period, Enterobacter cloacae was isolated from throughout the water distribution system in New Haven County, Connecticut. There was no forewarning of this event and no apparent reasons for it. Several epidemiologic and public health questions required rapid answers. Were these E. cloacae isolates the result of treatment failure and breakthrough or was regrowth occurring within the system? Did the E. cloacae isolates represent a health threat and were they causing infection? Pulsed-field gel electrophoresis utilizing whole-cell DNA digestion with restriction endonuclease SpeI permitted the rapid generation of specific information to answer these questions. Gel bands were stained with ethidium bromide and photographed with UV illumination. Homogeneity among isolates was confirmed by repeat digestion with XbaI. From each of the water distribution isolates, a single pattern of restriction endonuclease fragments was generated, indicating that only one clone of E. cloacae was in the distribution system. There was no homogeneity between source and distribution water E. cloacae isolates. Moreover, E. cloacae clinical isolates from patients from New Haven area hospitals showed no identity with E. cloacae isolated from the distribution system. Therefore, pulsed-field gel electrophoresis DNA analysis demonstrated that the E. cloacae from the distribution system was the result of a regrowth bloom within the system and not the result of treatment failure and that this clone was not causing a public health risk.
Bacterial Typing Techniques↗
Networks in the radiology department and the hospital.
Data networks are a basic technology with regard to an appropriate design of the information technology (IT) infrastructure for the hospital. Due to the distributed workflow within the hospital, an integrated Hospital Information System (HIS) is based mostly on a set of network applications facing specific items. Medical communication standards, i.e., HL 7, DICOM, and in the near future the migration towards XML, support the interoperability between the IT subsystems and pave the way to patient information systems with access to unified and complete electronic medical records (EMR). Furthermore, with standardized communication techniques, such as CORBAmed, an object-oriented design of Healthcare applications will be possible in the near future. The intent of this paper is to give an overview of which basic technologies are suitable for building comprehensive, flexible, and reliable hospital networks and which also meet the special demands of the radiology department.
Computer Communication Networks↗
Legionella pneumophila grows adherent to surfaces in vitro and in situ.
Legionella pneumophila continues to play a role in both community- and nosocomially-acquired pneumonia. We investigated the ability of L pneumophila to adhere to various types of materials such as those found in the hospital air-cooling and portable water distribution systems. Through the use of a unique sampling apparatus, we were able to regularly acquire planktonic and sessile samples and determine the numbers of bacteria present in both populations, in vitro and in situ. Portions of these apparatuses could be aseptically removed for examination by scanning electron microscopy, or for the determination of the number of viable adherent L pneumophila. The number of bacteria present in each sample was determined by direct plate count, with presumptive L pneumophila colonies being positively identified by direct fluorescent antibody staining techniques. The results demonstrated that not only are legionellae capable of colonizing various metallic and nonmetallic surfaces but that they are preferentially found on surfaces. Surface-adherent bacteria may play a profound role as a reservoir of these potential pathogens in aquatic environments. Furthermore, these results suggest that any comprehensive legionella monitoring program must include not only water samples but also an examination of the adherent populations.
Air Conditioning↗
The use of length of stay distributions to predict hospital discharges.
Many hospital admissions scheduling or admissions control systems reported in the literature rely on estimates of future discharges to help control the variance in daily patient census. One of the two most frequently reported methods of estimating discharges attempts to explain the variance in historical length of stay (LPS) data. This paper explores the relationship between LOS variance explanation and the ability to predict discharges and concludes that even a large improvement in the ability to explain LOS variance will only marginally reduce the errors in the associated discharge predictions. In drawing this conclusion, a general discharge prediction model is developed and a more relevant statistic than per cent variance explained is introduced.
Admitting Department, Hospital↗
An analysis of an inflammatory bowel disease practice in an urban community hospital.
OBJECTIVES: To review an individual community gastroenterologist's experience with inflammatory bowel disease (IBD). The aspects studied were distribution of disease, need for hospital admission, immunosuppressants, systemic steroids, and surgery and its indications. The incidence of cancer was also reviewed. PATIENTS AND METHODS: The charts of all IBD patients (n=373) seen between 1993 and 1996 by an individual gastroenterologist in an urban community hospital were reviewed for the aforementioned information. Patients seen during this period may have been diagnosed with IBD before or during the period of 1993 to 1996. RESULTS: Of the 373 patients, 219 had Crohn's disease (CD) and 154 had ulcerative colitis (UC). The most common age of onset for both groups was 20 to 29 years. Distal UC and distal Crohn's colitis patients rarely required surgery, hospitalization, systemic steroids or immunosuppressants. Eighty per cent of patients with small bowel CD and 51% of those with ileocolonic CD required at least one operation. Of the UC patients, 10.4% required surgery. Of the UC patients undergoing surveillance for cancer, none developed cancer but one developed significant dysplasia. CONCLUSIONS: In both CD and UC the site of the inflammation plays a major role in determining the need for hospitalization, surgery, systemic steroids and immunosuppressants. Distal UC, the most common form of UC in this group of patients, is a very benign disease. Of all forms of IBD, small bowel CD had the greatest need for hospitalization, surgery and systemic steroids.
Adult↗
Age-dependent inaccuracy of asthma death certification in Northern England, 1991-1992.
Asthma mortality appeared to increase two-fold in the UK from the mid- 1970s to the early 1990s, but there is evidence of inaccuracy in asthma death certification and so a region-wide investigation was undertaken to assess whether this recorded statistical trend might have been partly or wholly artefactual. A total of 35 respiratory physicians, distributed in panels of three, systemically reviewed the hospital and general practice records of 210 subjects with physician-diagnosed asthma who died in 1991 and 1992. The death certificates indicated that asthma was considered to be the primary cause of death in 103 (group 1), a contributory cause in 70 (group 2) and not relevant in 37 (group 3). There was agreement within the panels that 43% of the subjects had probably never suffered from asthma. Discordance between the panels and the certifying physicians over the correct death certification category was high for group 1 (45% for those aged <65 yrs, 75% for those aged > or =65 yrs and 64% overall) and group 2 (67%), but much less for group 3 (22%). This study concludes that asthma death certification provides a markedly inaccurate picture of asthma mortality, particularly in elderly subjects. Thus, it is speculated that if the magnitude of this source of inaccuracy has increased over the last two decades, the apparent recent increase in asthma mortality may be largely artefactual.
Aged↗
Distribution accuracy of a decentralized unit dose system.
Unit dose medication carts in a 500-bed university hospital were monitored for accuracy and completeness after delivery to the nursing station. The contents of the cart were compared with the nurse's patient medication record. Discrepancies were recorded for evaluation. All medication cart distribution errors found were analyzed to identify the source and were tabulated to determine error rate. Three major categories of errors were discovered: pharmacy technician errors not corrected by the pharmacist, errors associated with nurse's patient medication records, and errors resulting from lost orders.
Medication Errors↗
Presentation of clinical guidelines via a rule-based expert charting system.
This paper discusses the theoretical basis and cumulative experience with EDECS, the Emergency Department Expert Charting System. This rule-based expert-system introduces clinical guidelines into the flow of patient care while creating the medical record and patient aftercare instructions.
California↗
[The benefits of computerized anticancer drug distribution].
Medication errors can lead to treatment failure and adverse drug reactions with potentially life-threatening consequences, especially when the patient is fragile or the drug is highly toxic. Both these latter factors are frequent in the cancer setting. Computers can be used to securitize the prescription (through validated protocols), preparation and administration of anticancer drugs, including experimental drugs, as they can store a wealth of information on both the individual patient and the product. We report our experience at Hotel-Dieu Hospital in Paris, where a computerized anticancer drug distribution system has increased treatment safety, provided major cost savings, and allowed nurses to spend more time with their patients.
Antineoplastic Agents↗